NPIMap

Organization Active NPI

Vine Street Clinical Associates, LLC

  • Psychiatry Physician
  • Springfield, IL
National Provider Identifier
1356625966
Registry record updated Sep 30, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
VINE STREET CLINICAL ASSOCIATES, LLC
Practice address
3225 Hedley Rd
Springfield, IL 62711-6248
Phone
(217) 726-7300
NPI assigned
Sep 30, 2011
Last updated
Sep 30, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 30, 2011

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

Authorized official

Name
J Travis Dowell
Title
Vice President MPS and Operations
Phone
(217) 788-3342

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0800X Primary
Adult Psychiatric/Mental Health Clinical Nurse SpecialistGroup: 193200000X MULTI-SPECIALTY GROUP 364SP0809X

Addresses

Primary practice location

3225 Hedley Rd
Springfield, IL 62711-6248

Mailing address

PO Box 3428
Springfield, IL 62708-3428
Phone (800) 577-5368

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

3225 Hedley Rd
Springfield, IL 62711
Phone (217) 726-6700

Practitioners & affiliated clinicians

Practitioners 3

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": "1317340800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1317340800000",
    "number": "1356625966",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3428",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627083428",
            "telephone_number": "800-577-5368",
            "fax_number": "217-757-2021"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3225 HEDLEY RD",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627116248",
            "telephone_number": "217-726-7300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VINE STREET CLINICAL ASSOCIATES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-09-30",
        "last_updated": "2011-09-30",
        "status": "A",
        "authorized_official_last_name": "DOWELL",
        "authorized_official_first_name": "J TRAVIS",
        "authorized_official_title_or_position": "VICE PRESIDENT MPS AND OPERATIONS",
        "authorized_official_telephone_number": "217-788-3342"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "364SP0809X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Clinical Nurse Specialist, Psychiatric/Mental Health, Adult",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Springfield, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.