NPIMap

Organization Active NPI

Bushnell Family Practice, SC

  • Family Medicine Physician
  • Bushnell, IL
National Provider Identifier
1316096399
Registry record updated Nov 3, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
036062336 Issued in IL
Legal business name
BUSHNELL FAMILY PRACTICE, SC
Practice address
155 W Hail St
Bushnell, IL 61422-1346
Phone
(309) 772-9444
Fax
(309) 772-6446
NPI assigned
Jan 9, 2007
Last updated
Nov 3, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 3, 2009

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

Authorized official

Name
John Arnold, M.D.NPI 1154327526
Title
President
Phone
(309) 772-9444

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 036062336 IL Primary

Addresses

Primary practice location

155 W Hail St
Bushnell, IL 61422-1346

Mailing address

PO Box 446
Macomb, IL 61455-0446
Phone (309) 833-2868

Other identifiers 4

IdentifierTypeStateIssuer
036062336MedicaidIL
014509OtherILHEALTH ALLIANCE
5515957OtherILBLUE CROSS BLUE SHIELD
148952OtherILMEDICARE PART A

National Provider Directory

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, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1168300800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1257206400000",
    "number": "1316096399",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 446",
            "city": "MACOMB",
            "state": "IL",
            "postal_code": "614550446",
            "telephone_number": "309-833-2868",
            "fax_number": "309-836-3779"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "155 W HAIL ST",
            "city": "BUSHNELL",
            "state": "IL",
            "postal_code": "614221346",
            "telephone_number": "309-772-9444",
            "fax_number": "309-772-6446"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BUSHNELL FAMILY PRACTICE, SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-09",
        "last_updated": "2009-11-03",
        "status": "A",
        "authorized_official_last_name": "ARNOLD",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "309-772-9444",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036062336",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036062336",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH ALLIANCE",
            "identifier": "014509",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "5515957",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PART A",
            "identifier": "148952",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bushnell, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.