Nationwide Medical Network

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

Legal business name

NATIONWIDE MEDICAL NETWORK

Practice address

1333 Central Park Drive Suite 102
O Fallon, IL 62269

Phone

(618) 477-4960

NPI assigned

Oct 18, 2021

Organization subpart

No

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

Addresses

Other identifiers 2

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.

• Nationwide Medical Network LLC

  • General Practice Physician
  • O Fallon, IL
  • NPI 1548924152
  NPD tax ID

Locations

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

{
    "created_epoch": "1634515200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1634515200000",
    "number": "1578226569",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4020 GREEN MOUNT CROSSING DR STE 143",
            "city": "O FALLON",
            "state": "IL",
            "postal_code": "622697287"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1333 CENTRAL PARK DRIVE SUITE 102",
            "city": "O FALLON",
            "state": "IL",
            "postal_code": "62269",
            "telephone_number": "618-477-4960"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NATIONWIDE MEDICAL NETWORK",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-10-18",
        "last_updated": "2021-10-18",
        "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": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ARTICLES OF  ORGANIZATION",
            "identifier": "10892503",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ARTICLES OF ORANIZATION",
            "identifier": "10892503",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kazuna Nakama
• Patrick Nakashima-Moran, D.O.
• Candace Esther Nall
• Kristina Naseer, M.D.
• Anne Nicole Nash, M.D.
• Nationwide Medical Network LLC
• Deysi Nava
• Karina Nava, MD
• Robert Nave
• Chiagoziem Jane Ndulue, MD

• General Practice Physician in O Fallon, IL
• Providers in O Fallon, IL by specialty
• General Practice Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 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.