NPIMap

Organization Active NPI

Nationwide Medical Network LLC

  • General Practice Physician
  • O Fallon, IL
National Provider Identifier
1548924152
Registry record updated Oct 29, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
NATIONWIDE MEDICAL NETWORK LLC
Practice address
4020 Green Mount Crossing Dr
O Fallon, IL 62269-7287
Phone
(618) 477-9640
NPI assigned
Oct 29, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 29, 2021

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

Authorized official

Name
Racheal Hannah
Title
Managing Director
Phone
(618) 477-9640

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 208D00000X Primary

Addresses

Primary practice location

4020 Green Mount Crossing Dr
O Fallon, IL 62269-7287

Mailing address

4020 Green Mount Crossing Dr Ste 143
Shiloh, IL 62269-7287

National Provider Directory

National Provider Directory
Tax ID family
Nationwide Medical Network2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

NPI Registry JSON

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

{
    "created_epoch": "1635465600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1635465600000",
    "number": "1548924152",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4020 GREEN MOUNT CROSSING DR STE 143",
            "city": "SHILOH",
            "state": "IL",
            "postal_code": "622697287"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4020 GREEN MOUNT CROSSING DR",
            "city": "O FALLON",
            "state": "IL",
            "postal_code": "622697287",
            "telephone_number": "618-477-9640"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NATIONWIDE MEDICAL NETWORK LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-10-29",
        "last_updated": "2021-10-29",
        "certification_date": "2021-09-27",
        "status": "A",
        "authorized_official_last_name": "HANNAH",
        "authorized_official_first_name": "RACHEAL",
        "authorized_official_title_or_position": "MANAGING DIRECTOR",
        "authorized_official_telephone_number": "618-477-9640"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in O Fallon, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2021; 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.