NPIMap

Organization Active NPI

Dolly Briscoe Enterprises, Inc.

  • Health Educator
  • Mt Zion, IL
National Provider Identifier
1447555685
Registry record updated Apr 3, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Health EducatorTaxonomy code 174H00000X
Legal business name
DOLLY BRISCOE ENTERPRISES, INC.
Practice address
1045 N State Highway 121
Mt Zion, IL 62549-1219
Phone
(217) 864-2085
Fax
(217) 864-2324
NPI assigned
Jan 19, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 3, 2023

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

Authorized official

Name
Ms. Kendall Kae Dolly
Title
President
Phone
(217) 454-5340

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Health EducatorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 174H00000X IL Primary
Health EducatorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 174H00000X

Addresses

Primary practice location

1045 N State Highway 121
Mt Zion, IL 62549-1219

Mailing address

1045 N State Highway 121
Mt Zion, IL 62549-1219
Phone (217) 864-2085

Other names 1

  • Physician's Choice Wellness Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20130603000294 IL Part B Supplier - Clinic/Group Practice 6709024755 Receives reassigned benefits from 6 practitioners
Practice locations: Mt Zion, IL
O20230626001117 IL Part B Supplier - Clinic/Group Practice 1951769843 Receives reassigned benefits from 4 practitioners
Practice locations: Forsyth, IL; Mt. Zion, IL; Effingham, IL

National Provider Directory

National Provider Directory

Locations

1105 W Saint Anthony Ave
Effingham, IL 62401
Phone (217) 855-8808

151 W Village Pkwy
Mt Zion, IL 62549
Phone (217) 675-7285

Practitioners & affiliated clinicians

Practitioners 14

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

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1295395200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1680480000000",
    "number": "1447555685",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1045 N STATE HIGHWAY 121",
            "city": "MT ZION",
            "state": "IL",
            "postal_code": "625491219",
            "telephone_number": "217-864-2085",
            "fax_number": "217-864-2324"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1045 N STATE HIGHWAY 121",
            "city": "MT ZION",
            "state": "IL",
            "postal_code": "625491219",
            "telephone_number": "217-864-2085",
            "fax_number": "217-864-2324"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DOLLY BRISCOE ENTERPRISES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-01-19",
        "last_updated": "2023-04-03",
        "certification_date": "2023-04-03",
        "status": "A",
        "authorized_official_last_name": "DOLLY",
        "authorized_official_first_name": "KENDALL",
        "authorized_official_middle_name": "KAE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "217-454-5340",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "174H00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Health Educator",
            "state": "IL",
            "license": null,
            "primary": true
        },
        {
            "code": "174H00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Health Educator",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Physician's Choice Wellness",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mt Zion, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.