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Chestnut Health Systems Inc

Organization Active NPI Substance Use Disorder Rehabilitation Clinic/Center · Bloomington, IL

NPI 1366431686 · NPPES record last updated Mar 16, 2023

Key facts

NPI
1366431686
Entity type
Organization (NPI type 2)
Primary specialty
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X
Legal business name
CHESTNUT HEALTH SYSTEMS INC
Practice address
1003 Martin Luther King Dr
Bloomington, IL 61701-1429
Phone
(309) 827-6026
Fax
(309) 820-1386
NPI assigned
Oct 19, 2005
Organization subpart
No

Authorized official

Name
Megan Marie Taylor
Title
Managed Care Supervisor
Phone
(888) 924-3786

Other NPIs on the same Medicare enrollment 2

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

Other NPIs with the same Medicare PAC ID 5

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Practitioners 112

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

View all 112

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in IL, MO

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20040603000738 IL Part B Supplier - Clinic/Group Practice 1052393063 Receives reassigned benefits from 90 practitioners
2 other NPIs on this enrollment
Practice locations: Belleville, IL; Bloomington, IL; Granite City, IL; Maryville, IL; Wood River, IL
O20201008002798 MO Part B Supplier - Clinic/Group Practice 1052393063 Receives reassigned benefits from 15 practitioners
Practice locations: Hillsboro, MO; De Soto, MO

National Provider Directory

Locations

400 Boyd St
De Soto, MO 63020

102 4th St
Hillsboro, MO 63050
Phone (636) 638-2618

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X Yes
Substance Abuse Rehabilitation Facility 324500000X

Addresses

Primary practice location

1003 Martin Luther King Dr
Bloomington, IL 61701-1429

Mailing address

1003 Martin Luther King Dr
Bloomington, IL 61701-1429

Other identifiers

IdentifierTypeStateIssuer
04023MedicaidIL
C/A-0126-0007-AMedicaidIL

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Mar 16, 2023.

{
    "created_epoch": "1129680000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678924800000",
    "number": "1366431686",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1003 MARTIN LUTHER KING DR",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617011429"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1003 MARTIN LUTHER KING DR",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617011429",
            "telephone_number": "309-827-6026",
            "fax_number": "309-820-1386"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHESTNUT HEALTH SYSTEMS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-19",
        "last_updated": "2023-03-16",
        "certification_date": "2023-03-16",
        "status": "A",
        "authorized_official_last_name": "TAYLOR",
        "authorized_official_first_name": "MEGAN",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "MANAGED CARE SUPERVISOR",
        "authorized_official_telephone_number": "888-924-3786"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "04023",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "C/A-0126-0007-A",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bloomington, IL

All providers in Bloomington, IL · Substance Use Disorder Rehabilitation Clinic/Center in Illinois

Sources for this page

Verify at the official NPI Registry.