Family Medical Clinic PLLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

FAMILY MEDICAL CLINIC PLLC

Practice address

1480 N Green Mount Rd Suite 200
O Fallon, IL 62269-3466

Phone

(618) 622-3450

Fax

(618) 622-3468

NPI assigned

Feb 20, 2019

Organization subpart

No

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

Authorized official

Name

Jacqueline Mudd

Title

Authorized Official

Phone

(217) 324-1100

Specialties & licenses 2

Addresses

Other identifiers 1

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

{
    "created_epoch": "1550620800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1593648000000",
    "number": "1477019909",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 483",
            "city": "LITCHFIELD",
            "state": "IL",
            "postal_code": "620560483",
            "telephone_number": "217-324-1100",
            "fax_number": "217-324-1103"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1480 N GREEN MOUNT RD SUITE 200",
            "city": "O FALLON",
            "state": "IL",
            "postal_code": "622693466",
            "telephone_number": "618-622-3450",
            "fax_number": "618-622-3468"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY MEDICAL CLINIC PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-02-20",
        "last_updated": "2020-07-02",
        "certification_date": "2020-07-02",
        "status": "A",
        "authorized_official_last_name": "MUDD",
        "authorized_official_first_name": "JACQUELINE",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "217-324-1100"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE PTAN",
            "identifier": "DZ1647",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Rick K Fagan, LCPC
• Kristen Noel Fairbank
• Madison Leigh Fallis, DO
• Family Connections, LLC
• Family Eye Care of Ofallon PC
• Bachir Farah, M.D.
• Brittany Farris
• Ferrell Chiropractic, LLC
• Joshua Theodore Ferrell, D.C.
• Neve Lillian Fielding, PA-C

• Internal Medicine Physician in O Fallon, IL
• Providers in O Fallon, IL by specialty
• Internal Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 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.