NPIMap

Organization Active NPI

15 Park Place LLC

Doing business as Adult Internal Medicine Office Practice

  • Internal Medicine Physician
  • Swansea, IL
National Provider Identifier
1447870274
Registry record updated Jul 8, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
15 PARK PLACE LLC
Doing business as
Adult Internal Medicine Office Practice
Practice address
15 Park PL Ste 1
Swansea, IL 62226-2918
Phone
(618) 580-1359
Fax
(618) 234-7242
NPI assigned
Apr 22, 2020
Last updated
Jul 8, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2020

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

Authorized official

Name
Clara Ampadu, FNPCNPI 1578096806
Title
Ceo
Phone
(618) 580-1359

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Nurse Practitioner 363LP2300X NU
Internal Medicine Physician 207R00000X NU Primary

Addresses

Primary practice location

15 Park PL Ste 1
Swansea, IL 62226-2918

Mailing address

15 Park PL Ste 1
Swansea, IL 62226-2918
Phone (618) 580-1359

Other identifiers 1

IdentifierTypeStateIssuer
0360832704MedicaidIL

Other names 1

  • Adult Internal Medicine Office Practice Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address ceeampadunp@ampadumed.com Direct

National Provider Directory

National Provider Directory

Locations

15 Park Pl
Ste 1
Swansea, IL 62226
Phone (618) 580-1359

Practitioners & affiliated clinicians

Practitioners 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1587513600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1594166400000",
    "number": "1447870274",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 PARK PL STE 1",
            "city": "SWANSEA",
            "state": "IL",
            "postal_code": "622262918",
            "telephone_number": "618-580-1359",
            "fax_number": "618-234-7242"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15 PARK PL STE 1",
            "city": "SWANSEA",
            "state": "IL",
            "postal_code": "622262918",
            "telephone_number": "618-580-1359",
            "fax_number": "618-234-7242"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "15 PARK PLACE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-04-22",
        "last_updated": "2020-07-08",
        "certification_date": "2020-07-08",
        "status": "A",
        "authorized_official_last_name": "AMPADU",
        "authorized_official_first_name": "CLARA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "618-580-1359",
        "authorized_official_credential": "FNPC"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0360832704",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ceeampadunp@ampadumed.com",
            "affiliation": "N",
            "endpointDescription": "business email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "ceeampadunp@ampadumed.com",
            "address_1": "15 Park Pl Ste 1",
            "city": "Swansea",
            "state": "IL",
            "country_code": "US",
            "postal_code": "622262918",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Adult Internal Medicine Office Practice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Swansea, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2020; 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.