NPIMap

Organization Active NPI

Integrated Medical Group LTD

  • Chiropractor
  • Edwardsville, IL
National Provider Identifier
1487750691
Registry record updated Jul 11, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
038010423 Issued in IL
Legal business name
INTEGRATED MEDICAL GROUP LTD
Practice address
435 S Buchanan St Ste B
Edwardsville, IL 62025-2091
Phone
(618) 692-6700
Fax
(618) 692-6711
NPI assigned
Sep 15, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 11, 2008

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

Authorized official

Name
David Thayer, DCNPI 1689642951
Title
Owner
Phone
(618) 692-6700

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 111N00000X 038009512 IL
ChiropractorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 111N00000X 038010423 IL Primary
ChiropractorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 111N00000X 038010464 IL

Addresses

Primary practice location

435 S Buchanan St Ste B
Edwardsville, IL 62025-2091

Mailing address

PO Box 997
Edwardsville, IL 62025-0997
Phone (618) 692-6700

Other identifiers 1

IdentifierTypeStateIssuer
583609003OtherILDME NUMBER

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20061215000438 IL Part B Supplier - Clinic/Group Practice 9032118286 Receives reassigned benefits from 4 practitioners
Practice locations: Glen Carbon, IL; Highland, IL

National Provider Directory

National Provider Directory
Tax ID family
Integrated Medical Group LTD9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

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

Locations

8 Ginger Creek Pkwy
Glen Carbon, IL 62034
Phone (618) 656-6790

213 W College Ave
Greenville, IL 62246
Phone (618) 692-6700

Practitioners & affiliated clinicians

Practitioners 4

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

NPI Registry JSON

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

{
    "created_epoch": "1158278400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1215734400000",
    "number": "1487750691",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 997",
            "city": "EDWARDSVILLE",
            "state": "IL",
            "postal_code": "620250997",
            "telephone_number": "618-692-6700",
            "fax_number": "618-692-6711"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "435 S BUCHANAN ST STE B",
            "city": "EDWARDSVILLE",
            "state": "IL",
            "postal_code": "620252091",
            "telephone_number": "618-692-6700",
            "fax_number": "618-692-6711"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTEGRATED MEDICAL GROUP LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-15",
        "last_updated": "2008-07-11",
        "status": "A",
        "authorized_official_last_name": "THAYER",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "618-692-6700",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "IL",
            "license": "038009512",
            "primary": false
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "IL",
            "license": "038010423",
            "primary": true
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "IL",
            "license": "038010464",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DME NUMBER",
            "identifier": "583609003",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Edwardsville, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2008; 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.