Kaskaskia Medical Center, LTD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

036097600 Issued in IL

Legal business name

KASKASKIA MEDICAL CENTER, LTD

Practice address

1003 N 8TH St
Vandalia, IL 62471-1238

Phone

(618) 283-4445

Fax

(618) 283-4446

NPI assigned

Jan 3, 2006

Last updated

Mar 26, 2018By 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

Michael Darmadi, MDNPI 1184601577

Title

Medical Director

Phone

(618) 283-4445

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Locations

Practitioners 1

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.

• Michael Darmadi, MD

  • Internal Medicine Physician
  • Vandalia, IL
  • NPI 1184601577
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1136246400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1522022400000",
    "number": "1508844325",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1003 N 8TH ST",
            "city": "VANDALIA",
            "state": "IL",
            "postal_code": "624711238",
            "telephone_number": "618-283-4445",
            "fax_number": "618-283-4446"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1003 N 8TH ST",
            "city": "VANDALIA",
            "state": "IL",
            "postal_code": "624711238",
            "telephone_number": "618-283-4445",
            "fax_number": "618-283-4446"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KASKASKIA MEDICAL CENTER, LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-03",
        "last_updated": "2018-03-26",
        "status": "A",
        "authorized_official_last_name": "DARMADI",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "618-283-4445",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036097600",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IL",
            "license": "036097600",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036097600",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Colten Lee Hunter, DMD
• Melissa Hutchison
• Katie Leann Ireland, PHARM D
• J Cox Enterprises LTD
• Ethan Jones, MA
• Tanea L Kinkead, M.A., BCBA, LBA
• Alicia Brianne Kniepkamp, RDH
• Nicole Kough
• Matthew Earl Labertew, DC
• Rebecca Amelia Lambert, M.S.ED.

• Internal Medicine Physician in Vandalia, IL
• Providers in Vandalia, 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 Mar 26, 2018; 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.