Mathers Clinic, LLC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

License

036054365 Issued in IL

Legal business name

MATHERS CLINIC, LLC

Practice address

145 S Virginia St
Crystal Lake, IL 60014-7226

Phone

(815) 444-9999

Fax

(815) 986-1363

NPI assigned

Mar 4, 2016

Organization subpart

No

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

Authorized official

Name

Ramesh B Vemuri, M.D.

Title

Owner

Phone

(815) 444-9999

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Other NPIs on the same Medicare enrollment 3

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

• Mathers Clinic LLC

  dba Mathers Clinic

  • Psychiatry Physician
  • Crystal Lake, IL
  • NPI 1316237530

  O20110411000671

  Same enrollment
• Mathers Clinic, LLC

  • Community/Behavioral Health Agency
  • Elgin, IL
  • NPI 1821457714

  O20110411000671

  Same enrollment
• The Mathers Clinic LLC

  • Community/Behavioral Health Agency
  • Woodstock, IL
  • NPI 1316307259

  O20110411000671

  Same enrollment

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

{
    "created_epoch": "1457049600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1485302400000",
    "number": "1447610381",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "145 S VIRGINIA ST",
            "city": "CRYSTAL LAKE",
            "state": "IL",
            "postal_code": "600147226",
            "telephone_number": "815-444-9999",
            "fax_number": "815-986-1363"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "145 S VIRGINIA ST",
            "city": "CRYSTAL LAKE",
            "state": "IL",
            "postal_code": "600147226",
            "telephone_number": "815-444-9999",
            "fax_number": "815-986-1363"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MATHERS CLINIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-03-04",
        "last_updated": "2017-01-25",
        "status": "A",
        "authorized_official_last_name": "VEMURI",
        "authorized_official_first_name": "RAMESH",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "815-444-9999",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "IL",
            "license": "036054365",
            "primary": true
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "IL",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Reilly Anne Martin
• Heather Masters, RD
• Jessica Mata
• Glen T Matejka, DN DC DACBN CCN
• Mathers Clinic LLC (Mathers Clinic)
• Mathers Community Mental Health Center LLC
• Mathers Recovery LLC
• Nisha Mathew
• Brittany S Matthiesen, LSW
• Barbara Maulding, LCPC

• Community/Behavioral Health Agency in Crystal Lake, IL
• Providers in Crystal Lake, IL by specialty
• Community/Behavioral Health Agency in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2017; 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.