Active NPI
Mid-Illinois Medical Care Associates, LLC
- Rural Health Clinic/Center
- Effingham, IL
National Provider Identifier
1568651925
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Rural Health Clinic/Center
- Legal business name
- MID-ILLINOIS MEDICAL CARE ASSOCIATES, LLC
- Practice address
- 900 W Temple Ave Ste 205
Effingham, IL 62401-2187 - Phone
- (217) 347-0458
- Fax
- (217) 342-2992
- NPI assigned
- Oct 22, 2007
- Organization subpart
- Yes
- Parent organization
- MID-ILLINOIS MEDICAL CARE ASSOCIATES, LLC
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Eugene P. Dust, M.D.
- Title
- President of LLC
- Phone
- (217) 347-5917
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | Primary |
Addresses
Primary practice location
900 W Temple Ave Ste 205
Effingham, IL 62401-2187
Mailing address
1207 Network Centre Dr Ste 3
Effingham, IL 62401-4632
Phone (217) 347-2707
Other names 1
- Dr. Dust
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Part of
- Mid Illinois Medical Ca
Ownership & related parties
Change-of-ownership history 1
| Date | Event | Counterparty |
|---|---|---|
| Oct 30, 2018 | Change of Ownership | HSHS Medical Group Family & Internal Medicine - Effingham |
Change of ownership 1
Medicare changes of ownership in which this facility was the buyer or the seller.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1193011200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1501545600000",
"number": "1568651925",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1207 NETWORK CENTRE DR STE 3",
"city": "EFFINGHAM",
"state": "IL",
"postal_code": "624014632",
"telephone_number": "217-347-2707",
"fax_number": "217-347-2827"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "900 W TEMPLE AVE STE 205",
"city": "EFFINGHAM",
"state": "IL",
"postal_code": "624012187",
"telephone_number": "217-347-0458",
"fax_number": "217-342-2992"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "MID-ILLINOIS MEDICAL CARE ASSOCIATES, LLC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "MID-ILLINOIS MEDICAL CARE ASSOCIATES, LLC",
"enumeration_date": "2007-10-22",
"last_updated": "2017-08-01",
"status": "A",
"authorized_official_last_name": "DUST",
"authorized_official_first_name": "EUGENE",
"authorized_official_middle_name": "P.",
"authorized_official_title_or_position": "PRESIDENT OF LLC",
"authorized_official_telephone_number": "217-347-5917",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "M.D."
},
"taxonomies": [
{
"code": "261QR1300X",
"taxonomy_group": "",
"desc": "Clinic/Center, Rural Health",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Dr. Dust",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Effingham, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.