NPIMap

Organization Active NPI

Deaconess Illinois Specialty Clinic, Inc.

  • Rural Health Clinic/Center
  • Benton, IL
National Provider Identifier
1578417705
Registry record updated Mar 12, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
DEACONESS ILLINOIS SPECIALTY CLINIC, INC.
Practice address
205 Bailey LN Ste F
Benton, IL 62812-1921
Phone
(618) 918-0645
Fax
(618) 918-6046
NPI assigned
Feb 24, 2026
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 12, 2026

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

Authorized official

Name
Kyle Dillman
Title
Secretary
Phone
(812) 450-7399

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

205 Bailey LN Ste F
Benton, IL 62812-1921

Mailing address

205 Bailey LN Ste F
Benton, IL 62812-1921
Phone (618) 918-0645

Other names 1

  • Deaconess Illinois Clinic GI and Family Medicine Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Deaconess Illinois Specialty Clinic Inc19 organizations share this tax ID, including this one

Other organizations with this tax ID 18

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

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1771891200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1773273600000",
    "number": "1578417705",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "205 BAILEY LN STE F",
            "city": "BENTON",
            "state": "IL",
            "postal_code": "628121921",
            "telephone_number": "618-918-0645",
            "fax_number": "618-918-6046"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "205 BAILEY LN STE F",
            "city": "BENTON",
            "state": "IL",
            "postal_code": "628121921",
            "telephone_number": "618-918-0645",
            "fax_number": "618-918-6046"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEACONESS ILLINOIS SPECIALTY CLINIC, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-02-24",
        "last_updated": "2026-03-12",
        "certification_date": "2026-03-12",
        "status": "A",
        "authorized_official_last_name": "DILLMAN",
        "authorized_official_first_name": "KYLE",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "812-450-7399"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Deaconess Illinois Clinic GI and Family Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Benton, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2026; 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.