NPIMap

Organization Active NPI

Deaconess Illinois Clinic, Inc

Doing business as Deaconess Illinois Clinic John A Logan

  • Family Medicine Physician
  • Carterville, IL
National Provider Identifier
1326836206
Registry record updated May 7, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
DEACONESS ILLINOIS CLINIC, INC
Doing business as
Deaconess Illinois Clinic John A Logan
Practice address
700 Logan College Drive
J Building
Carterville, IL 62918
Phone
(618) 926-6698
NPI assigned
Apr 29, 2025
Last updated
May 7, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 7, 2025

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

Authorized official

Name
Kyle Dillman
Title
Secretary Treasurer
Phone
(812) 450-7399

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X Primary
Nurse Practitioner 363L00000X

Addresses

Primary practice location

700 Logan College Drive
J Building
Carterville, IL 62918

Mailing address

PO Box 632330
Cincinnati, OH 45263-2330
Phone (618) 219-1311

Other names 1

  • Deaconess Illinois Clinic John A Logan Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230220002667 IL Part B Supplier - Clinic/Group Practice 5092187021 Receives reassigned benefits from 33 practitioners
10 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Marion, IL; Waterloo, IL; Mount Vernon, IL; Harrisburg, IL; Columbia, IL; Carterville, IL; Benton, IL

Other NPIs on the same Medicare enrollment 10

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

National Provider Directory

National Provider Directory
Tax ID family
Deaconess Illinois Clinic21 organizations share this tax ID, including this one

Other organizations with this tax ID 20

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

View all 20

Locations

700 Logan College Dr
Carterville, IL 62918
Phone (618) 985-2828

700 Logan College Dr
#J
Carterville, IL 62918
Phone (618) 926-6698

2703 17th St
Apt D
Marion, IL 62959
Phone (618) 998-9200

Practitioners & affiliated clinicians

Practitioners 34

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.

View all 34

NPI Registry JSON

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

{
    "created_epoch": "1745884800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1746576000000",
    "number": "1326836206",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 632330",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452632330",
            "telephone_number": "618-219-1311"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 LOGAN COLLEGE DRIVE",
            "address_2": "J BUILDING",
            "city": "CARTERVILLE",
            "state": "IL",
            "postal_code": "62918",
            "telephone_number": "618-926-6698"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEACONESS ILLINOIS CLINIC, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-04-29",
        "last_updated": "2025-05-07",
        "certification_date": "2025-05-07",
        "status": "A",
        "authorized_official_last_name": "DILLMAN",
        "authorized_official_first_name": "KYLE",
        "authorized_official_title_or_position": "SECRETARY TREASURER",
        "authorized_official_telephone_number": "812-450-7399"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Deaconess Illinois Clinic John A Logan",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Deaconess Illinois Clinic John A Logan",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Carterville, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 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.