NPIMap

Organization Active NPI

SHC Medical Partners of Illinois, LLC

  • Nurse Practitioner
  • Rock Island, IL
National Provider Identifier
1306523600
Registry record updated Dec 22, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
Legal business name
SHC MEDICAL PARTNERS OF ILLINOIS, LLC
Practice address
2545 24TH St
Rock Island, IL 61201-5305
Phone
(877) 558-8181
NPI assigned
Jun 29, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 22, 2023

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

Authorized official

Name
Sarah Altstadt
Title
Provider Enrollment Specialist
Phone
(502) 394-2100

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X Primary

Addresses

Primary practice location

2545 24TH St
Rock Island, IL 61201-5305

Mailing address

805 N Whittington Pkwy
Louisville, KY 40222-7101
Phone (502) 394-2100

Other names 1

  • Abode Care Partners Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230907003387 IL Part B Supplier - Clinic/Group Practice 1850755968 Receives reassigned benefits from 3 practitioners
Practice locations: Rock Island, IL

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 4

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

NPI Registry JSON

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

{
    "created_epoch": "1687996800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1703203200000",
    "number": "1306523600",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "805 N WHITTINGTON PKWY",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402227101",
            "telephone_number": "502-394-2100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2545 24TH ST",
            "city": "ROCK ISLAND",
            "state": "IL",
            "postal_code": "612015305",
            "telephone_number": "877-558-8181"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHC MEDICAL PARTNERS OF ILLINOIS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-06-29",
        "last_updated": "2023-12-22",
        "certification_date": "2023-12-22",
        "status": "A",
        "authorized_official_last_name": "ALTSTADT",
        "authorized_official_first_name": "SARAH",
        "authorized_official_title_or_position": "PROVIDER ENROLLMENT SPECIALIST",
        "authorized_official_telephone_number": "502-394-2100"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Abode Care Partners",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Abode Care Partners",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Rock Island, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.