NPIMap

Organization Active NPI

Premise Health of Illinois Medical PC

  • Multi-Specialty Clinic/Center
  • Utica, IL
National Provider Identifier
1295518868
Registry record updated Feb 10, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
PREMISE HEALTH OF ILLINOIS MEDICAL PC
Practice address
740 E US Highway 6 Ste B
Utica, IL 61373-9755
Phone
(815) 310-5750
Fax
(815) 310-1051
NPI assigned
Aug 16, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 10, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Edward William Schwartz
Title
President
Phone
(844) 407-7557

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X Primary

Addresses

Primary practice location

740 E US Highway 6 Ste B
Utica, IL 61373-9755

Mailing address

5500 Maryland Way Ste 120
Brentwood, TN 37027-4993

Other names 1

  • MCL Health Center - Utica Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120423000619 IL Part B Supplier - Clinic/Group Practice 3971764762 Receives reassigned benefits from 75 practitioners
9 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Countryside, IL; Utica, IL; Northbrook, IL; Mount Vernon, IL; Lisle, IL; Joliet, IL; Grayslake, IL; Elgin, IL…

Other NPIs on the same Medicare enrollment 9

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
14D2287978Premise Health of Illinois Medical, SC740 E US Hwy 6, Utica, IL 61373Certificate of waiverAug 18, 2027

National Provider Directory

National Provider Directory
Tax ID family
Premise Health of Illinois Medical PC24 organizations share this tax ID, including this one

Other organizations with this tax ID 23

Organizations that report the same tax identification number in the National Provider Directory.

View all 23

Locations

740 E US Highway 6
#B
Utica, IL 61373
Phone (815) 310-5750

Practitioners & affiliated clinicians

Practitioners 77

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 77

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1692144000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1770681600000",
    "number": "1295518868",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5500 MARYLAND WAY STE 120",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370274993"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "740 E US HIGHWAY 6 STE B",
            "city": "UTICA",
            "state": "IL",
            "postal_code": "613739755",
            "telephone_number": "815-310-5750",
            "fax_number": "815-310-1051"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMISE HEALTH OF ILLINOIS MEDICAL PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-08-16",
        "last_updated": "2026-02-10",
        "certification_date": "2026-02-10",
        "status": "A",
        "authorized_official_last_name": "SCHWARTZ",
        "authorized_official_first_name": "EDWARD",
        "authorized_official_middle_name": "WILLIAM",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "844-407-7557"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MCL Health Center - Utica",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "MCL Health Center - Utica",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Utica, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.