NPIMap

Organization Active NPI

Illinois Medicaid-Substance Abuse Monmouth

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Monmouth, IL
National Provider Identifier
1427425248
Registry record updated Aug 19, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X
Legal business name
ILLINOIS MEDICAID-SUBSTANCE ABUSE MONMOUTH
Practice address
301 Industrial Park Rd
Monmouth, IL 61462-9794
Phone
(309) 734-9461
NPI assigned
Aug 27, 2015
Last updated
Aug 19, 2019By the provider in NPPES
Organization subpart
Yes
Parent organization
BRIDGEWAY INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 19, 2019

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

Authorized official

Name
Mr. Bill A Nelson, LCPC
Title
Ceo
Phone
(309) 344-4200

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Methadone Clinic 261QM2800X IL
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X IL Primary
Addiction (Substance Use Disorder) Counselor 101YA0400X A-0118-0011-A IL
Psychiatry Physician 2084P0800X IL
Child & Adolescent Psychiatry Physician 2084P0804X IL

Addresses

Primary practice location

301 Industrial Park Rd
Monmouth, IL 61462-9794

Mailing address

301 Industrial Park Rd
Monmouth, IL 61462-9794
Phone (309) 734-9461

National Provider Directory

National Provider Directory
Tax ID family
Julio R Lozano MD15 organizations share this tax ID, including this one
Part of
Julio R Lozano MD

Other organizations with this tax ID 14

Organizations that report the same tax identification number in the National Provider Directory.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1440633600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1566172800000",
    "number": "1427425248",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 INDUSTRIAL PARK RD",
            "city": "MONMOUTH",
            "state": "IL",
            "postal_code": "614629794",
            "telephone_number": "309-734-9461"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 INDUSTRIAL PARK RD",
            "city": "MONMOUTH",
            "state": "IL",
            "postal_code": "614629794",
            "telephone_number": "309-734-9461"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ILLINOIS MEDICAID-SUBSTANCE ABUSE MONMOUTH",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BRIDGEWAY INC",
        "enumeration_date": "2015-08-27",
        "last_updated": "2019-08-19",
        "status": "A",
        "authorized_official_last_name": "NELSON",
        "authorized_official_first_name": "BILL",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "309-344-4200",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LCPC"
    },
    "taxonomies": [
        {
            "code": "261QM2800X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Methadone",
            "state": "IL",
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "IL",
            "license": null,
            "primary": true
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "IL",
            "license": "A-0118-0011-A",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "IL",
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "IL",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Monmouth, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2019; 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.