Medical Group of Macomb, LLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

MEDICAL GROUP OF MACOMB, LLC

Practice address

505 E Grant St Ste 103
Macomb, IL 61455-3308

Phone

(309) 833-3536

Fax

(309) 836-5729

NPI assigned

Oct 12, 2006

Organization subpart

No

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

Authorized official

Name

Dr. David Miller, D.O.

Title

President

Phone

(309) 833-3536

Specialties & licenses 2

Addresses

Other identifiers 7

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Mary Kathleen Lockard, M.D.

  • Pediatrics Physician
  • Macomb, IL
  • NPI 1679571152

  Pediatrics

  NPD
• Kymberly Danielle Lockard, APRN

  • Pediatrics Physician
  • Macomb, IL
  • NPI 1295455756

  Pediatrics

  NPD (past)
• Amber Rector, PA

  • Physician Assistant
  • Table Grove, IL
  • NPI 1225381791
  NPD (past)

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

{
    "created_epoch": "1160611200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1356430664",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 556",
            "city": "MACOMB",
            "state": "IL",
            "postal_code": "614550556",
            "telephone_number": "309-833-3536",
            "fax_number": "309-836-5729"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "505 E GRANT ST STE 103",
            "city": "MACOMB",
            "state": "IL",
            "postal_code": "614553308",
            "telephone_number": "309-833-3536",
            "fax_number": "309-836-5729"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICAL GROUP OF MACOMB, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-12",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "309-833-3536",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": null,
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": "IL",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "110247080",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS/BLUE SHIELD IL",
            "identifier": "5532005",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "DG6820",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036104354",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036111319",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH ALLIANCE",
            "identifier": "067033",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH ALLIANCE",
            "identifier": "095260",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• McDonough County Hospital District
• McDonough Eye Associates PC
• Janell McGruder, LCPC
• Kamie Dee McKee, NP-C
• Jack Lee McPherson, MD
• Xahara Alexandria Megod, MA, LCPC, R-DMT, CPT
• David L Miller, D.O.
• Shane Michael Miller, PHARMD
• Richard Earl Minter, D.O.
• Mitch and Chris Standard Inc.

• Internal Medicine Physician in Macomb, IL
• Providers in Macomb, IL by specialty
• Internal Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.