Optimal Health Medicine LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

036120316 Issued in IL

Legal business name

OPTIMAL HEALTH MEDICINE LLC

Practice address

1368 Dadrian Professional Park
Godfrey, IL 62035-1685

Phone

(618) 433-9701

Fax

(618) 433-9706

NPI assigned

Oct 15, 2012

Organization subpart

No

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

Authorized official

Name

Dr. Jon Anthony Wagnon, D.O.NPI 1265623268

Title

President

Phone

(618) 433-9701

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Locations

Practitioners 2

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.

• Jon Anthony Wagnon, D.O.

  • Emergency Medicine Physician
  • Godfrey, IL
  • NPI 1265623268
  Medicare reassignment Authorized official
• Mollie Elizabeth Dwivedi, PA

  • Physician Assistant
  • New York, NY
  • NPI 1710491337
  NPD (past)

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

{
    "created_epoch": "1350259200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1747180800000",
    "number": "1316299332",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1368 DADRIAN PROFESSIONAL PARK",
            "city": "GODFREY",
            "state": "IL",
            "postal_code": "620351685",
            "telephone_number": "618-433-9701",
            "fax_number": "618-433-9706"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1368 DADRIAN PROFESSIONAL PARK",
            "city": "GODFREY",
            "state": "IL",
            "postal_code": "620351685",
            "telephone_number": "618-433-9701",
            "fax_number": "618-433-9706"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPTIMAL HEALTH MEDICINE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-15",
        "last_updated": "2025-05-14",
        "certification_date": "2025-05-14",
        "status": "A",
        "authorized_official_last_name": "WAGNON",
        "authorized_official_first_name": "JON",
        "authorized_official_middle_name": "ANTHONY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "618-433-9701",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036120316",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• New Path Wellness LLC
• Lawrence E Newquist, DMD
• Nexus at Godfrey, LLC
• Allison C Nicklow, PHARMD
• Benedicta I Odemerho, FNP
• Osf Healthcare System (Osf Healthcare - Medical Group - Godfrey)
• Mary Elizabeth Pagano, FNP-C
• Parishi Patel, DO
• Morgan Peters, PA-C
• Julia Lynn Phillips, REGISTERED

• Family Medicine Physician in Godfrey, IL
• Providers in Godfrey, IL by specialty
• Family Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2025; 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.