Swedishamerican Hospital
Organization Active NPI Family Medicine Physician · Davis Junction, IL
NPI 1407908189 · NPPES record last updated Jul 12, 2018
Key facts
- NPI
- 1407908189
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- SWEDISHAMERICAN HOSPITAL
- Practice address
- 5665 N Junction Way
Davis Junction, IL 61020 - Phone
- (779) 696-9200
- NPI assigned
- Jan 16, 2007
- Organization subpart
- No
Authorized official
- Name
- Don Daniels
- Title
- VP
- Phone
- (815) 966-2084
Practitioners 16
-
Gayle R Crays, MD
-
Jeffrey David Gurtizen, D.O.
-
Sumaira Iqbal, M.D.
-
Kenneth Richard Nissim, M.D.
-
Mark Whitney, PA-C
-
Melanie Kate Zielke, APRN
-
Jessica M Van Beek-King, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031215000012 | IL | Part B Supplier - Clinic/Group Practice | 5799698346 |
Receives reassigned benefits from 506 practitioners This NPI is an additional NPI on the enrollment Practice locations: Rockford, IL; Roscoe, IL; Belvidere, IL; Rochelle, IL; Freeport, IL; Davis Junction, IL; Byron, IL |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | Yes | ||
| Nurse Practitioner |
363L00000X |
Addresses
Primary practice location
5665 N Junction Way
Davis Junction, IL 61020
Mailing address
PO Box 78866
Milwaukee, WI 53278-8866
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| CLIA | Other | IL | 14D0990463 |
Other names
- SA Davis Junction Clinic
Other providers in Davis Junction, IL
- Lynnville Scott White Rock FPD
- Sergio Martinez
- Mobile Imaging Solutions, Inc.
- Daniel R Retzer
- Margret M. Saint Louis
- Samantha Kristine Traum
- Brittney Wyatt
All providers in Davis Junction, IL · Family Medicine Physician in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 12, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.