Deaconess Illinois Specialty Clinic, Inc.
Organization Active NPI Emergency Medicine Physician · Marion, IL
NPI 1336845015 · NPPES record last updated Feb 3, 2023
Key facts
- NPI
- 1336845015
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Emergency Medicine Physician 207P00000X
- Legal business name
- DEACONESS ILLINOIS SPECIALTY CLINIC, INC.
- Practice address
- 3333 W Deyoung St
Marion, IL 62959-5884 - Phone
- (618) 998-7000
- Fax
- (618) 998-7449
- NPI assigned
- Feb 3, 2023
- Organization subpart
- No
Authorized official
- Name
- Mr. Kyle Dillman
- Title
- Secretary
- Phone
- (812) 450-7399
Other NPIs on the same Medicare enrollment 23
Practitioners 8
-
Kendall Barnes, PA-C
-
Nathaniel Clark, P.A.
-
Ahmed Soukat Ali, MD
-
John R. Trost, M.D.
-
Ashish Sharma, MD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20230321001688 | IL | Part B Supplier - Clinic/Group Practice | 9830562016 |
Receives reassigned benefits from 243 practitioners 23 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Marion, IL; West Frankfort, IL; Waterloo, IL; Salem, IL; Red Bud, IL; Mount Vernon, IL; Benton, IL; Harrisburg, IL… |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician |
207P00000X | Yes |
Addresses
Primary practice location
3333 W Deyoung St
Marion, IL 62959-5884
Mailing address
PO Box 34266
Belfast, ME 04915-0620
Phone (812) 450-6815
Other names
- Deaconess Illinois Emergency Room Physicians
Other providers in Marion, IL
- Deaconess Illinois Clinic, Inc
- Deaconess Illinois Clinic, Inc
- Deaconess Illinois Clinic, Inc
- Deaconess Illinois Specialty Clinic, Inc.
- Deaconess Illinois Specialty Clinic, Inc.
- Deaconess Illinois Specialty Clinic, Inc.
- Deaconess Illinois Specialty Clinic, Inc.
- Deaconess Illinois Specialty Clinic, Inc.
- Deaconess Illinois Surgery Center Marion, Inc
- Deaconess Regional Healthcare Services Illinois Inc
All providers in Marion, IL · Emergency Medicine Physician in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 3, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.