NPIMap

Organization Active NPI

Graham Hospital Association

Doing business as GMG South - Primary & Convenient Care Clinic

  • Family Medicine Physician
  • Galesburg, IL
National Provider Identifier
1346093937
Registry record updated Apr 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
GRAHAM HOSPITAL ASSOCIATION
Doing business as
GMG South - Primary & Convenient Care Clinic
Practice address
435 E 3Rd St
Galesburg, IL 61401-6023
Phone
(309) 647-0201
NPI assigned
Apr 11, 2024
Last updated
Apr 11, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 11, 2024

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

Authorized official

Name
Julie Reeder
Title
VP of Finance and Cfo
Phone
(309) 647-5240

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

435 E 3Rd St
Galesburg, IL 61401-6023

Mailing address

435 E 3Rd St
Galesburg, IL 61401-6023

Other names 1

  • GMG South - Primary & Convenient Care Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040510000873 IL Part B Supplier - Clinic/Group Practice 2769375021 Receives reassigned benefits from 139 practitioners
13 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Galesburg, IL; Williamsfield, IL; Macomb, IL; Lewistown, IL; Glasford, IL; Farmington, IL; Elmwood, IL; Canton, IL

Other NPIs on the same Medicare enrollment 13

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

View all 13

National Provider Directory

National Provider Directory
Tax ID family
Graham Hospital22 organizations share this tax ID, including this one

Other organizations with this tax ID 21

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

View all 21

Locations

435 E 3rd St
Galesburg, IL 61401

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": "1712793600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1712793600000",
    "number": "1346093937",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "435 E 3RD ST",
            "city": "GALESBURG",
            "state": "IL",
            "postal_code": "614016023"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "435 E 3RD ST",
            "city": "GALESBURG",
            "state": "IL",
            "postal_code": "614016023",
            "telephone_number": "309-647-0201"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRAHAM HOSPITAL ASSOCIATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-04-11",
        "last_updated": "2024-04-11",
        "certification_date": "2024-04-11",
        "status": "A",
        "authorized_official_last_name": "REEDER",
        "authorized_official_first_name": "JULIE",
        "authorized_official_title_or_position": "VP OF FINANCE AND CFO",
        "authorized_official_telephone_number": "309-647-5240"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "GMG South - Primary & Convenient Care Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Galesburg, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2024; 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.