NPIMap

Organization Active NPI

Premise Health of Illinois Medical PC

Doing business as Mount Vernon Health Center Mt Vernon

  • Primary Care Clinic/Center
  • Mount Vernon, IL
National Provider Identifier
1427366921
Registry record updated Feb 4, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
PREMISE HEALTH OF ILLINOIS MEDICAL PC
Doing business as
Mount Vernon Health Center Mt Vernon
Mount Vernon Healthy Living Center
Practice address
5100 Lake Terrance NE
Mount Vernon, IL 62864-9665
Phone
(618) 899-5001
NPI assigned
Sep 17, 2010
Last updated
Feb 4, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 4, 2026

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

Authorized official

Name
Edward William Schwartz
Title
President
Phone
(844) 407-7557

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X Primary
Occupational Medicine Clinic/Center 261QX0100X

Addresses

Primary practice location

5100 Lake Terrance NE
Mount Vernon, IL 62864-9665

Mailing address

5500 Maryland Way Ste 120
Brentwood, TN 37027-4993

Other names 2

  • Mount Vernon Health Center Mt Vernon Doing business as
  • Mount Vernon Healthy Living Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120423000619 IL Part B Supplier - Clinic/Group Practice 3971764762 Receives reassigned benefits from 75 practitioners
9 other NPIs on this enrollment
Practice locations: Countryside, IL; Utica, IL; Northbrook, IL; Mount Vernon, IL; Lisle, IL; Joliet, IL; Grayslake, IL; Elgin, IL…

Other NPIs on the same Medicare enrollment 9

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

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
14D2014391Premise Health of Illinois Medical, SC5100 Lake Terrace NE, Ste WC, Mount Vernon, IL 62864Certificate of waiverOct 6, 2026

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 78

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.

View all 78

NPI Registry JSON

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

{
    "created_epoch": "1284681600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1770163200000",
    "number": "1427366921",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5500 MARYLAND WAY STE 120",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370274993"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5100 LAKE TERRANCE NE",
            "city": "MOUNT VERNON",
            "state": "IL",
            "postal_code": "628649665",
            "telephone_number": "618-899-5001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMISE HEALTH OF ILLINOIS MEDICAL PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-09-17",
        "last_updated": "2026-02-04",
        "certification_date": "2026-02-04",
        "status": "A",
        "authorized_official_last_name": "SCHWARTZ",
        "authorized_official_first_name": "EDWARD",
        "authorized_official_middle_name": "WILLIAM",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "844-407-7557"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QX0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Occupational Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mount Vernon Health Center Mt Vernon",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Mount Vernon Healthy Living Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Mount Vernon Healthy Living Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mount Vernon, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.