NPIMap

Organization Active NPI

Passavant Memorial Area Hospital

  • Surgery Physician
  • Jacksonville, IL
National Provider Identifier
1366486771
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
Legal business name
PASSAVANT MEMORIAL AREA HOSPITAL
Practice address
1600 W Walnut St
Jacksonville, IL 62650-1136
Phone
(217) 479-5821
Fax
(217) 243-7406
NPI assigned
Jun 15, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Larry Ragel
Title
Cfo/Vice President of Finance
Phone
(217) 479-5527

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208600000X Primary

Addresses

Primary practice location

1600 W Walnut St
Jacksonville, IL 62650-1136

Mailing address

PO Box 1977
Springfield, IL 62705-1977
Phone (217) 544-6464

Other identifiers 3

IdentifierTypeStateIssuer
CB3741OtherILRR MEDICARE GROUP#
752951OtherILHEALTHLINK
06932023OtherILBLUE CROSS BLUE SHIELD

Other names 1

  • PASSAVANT SURGICAL ASSOCIATES Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

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

NPI Registry JSON

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

{
    "created_epoch": "1150329600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1366486771",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1977",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627051977",
            "telephone_number": "217-544-6464",
            "fax_number": "217-757-6021"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 W WALNUT ST",
            "city": "JACKSONVILLE",
            "state": "IL",
            "postal_code": "626501136",
            "telephone_number": "217-479-5821",
            "fax_number": "217-243-7406"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PASSAVANT MEMORIAL AREA HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-15",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "RAGEL",
        "authorized_official_first_name": "LARRY",
        "authorized_official_title_or_position": "CFO/VICE PRESIDENT OF FINANCE",
        "authorized_official_telephone_number": "217-479-5527"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE GROUP#",
            "identifier": "CB3741",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHLINK",
            "identifier": "752951",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "06932023",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PASSAVANT SURGICAL ASSOCIATES",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Jacksonville, IL

Sources for this page

  • 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.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.