Community Medical Center of Dwight PC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

036062435 Issued in IL

Legal business name

COMMUNITY MEDICAL CENTER OF DWIGHT PC

Practice address

103 S John St
Dwight, IL 60420-1413

Phone

(815) 584-3051

NPI assigned

Dec 10, 2009

Last updated

Feb 19, 2010By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Pamela Marie Cichon

Title

Office Manager

Phone

(815) 584-3051

Specialties & licenses 1

Addresses

Other identifiers 2

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

{
    "created_epoch": "1260403200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1266537600000",
    "number": "1487983060",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "103 S JOHN ST",
            "city": "DWIGHT",
            "state": "IL",
            "postal_code": "604201413",
            "telephone_number": "815-584-3051"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "103 S JOHN ST",
            "city": "DWIGHT",
            "state": "IL",
            "postal_code": "604201413",
            "telephone_number": "815-584-3051"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY MEDICAL CENTER OF DWIGHT PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-12-10",
        "last_updated": "2010-02-19",
        "status": "A",
        "authorized_official_last_name": "CICHON",
        "authorized_official_first_name": "PAMELA",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "815-584-3051"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036062435",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036062435",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "05315073",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Modinat Iretioluwa Bokin
• Marcie R Burton, COTA/L
• Cfac Incorporated
• Champion Fitness, Inc
• Michael Charles Cichon, D.O.
• Riley Grace Connolly
• Terah Anne Coughlin, PHARMD
• Jennifer Cracco
• Ryan Crowley
• David J Casper, O.D. (Dwight Vision Care Center)

• Family Medicine Physician in Dwight, IL
• Providers in Dwight, IL by specialty
• Family Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2010; 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.