NPIMap

Organization Active NPI

Crossroads Physician Corporation

  • Family Medicine Physician
  • Nashville, IL
National Provider Identifier
1629063698
Registry record updated Apr 27, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
CROSSROADS PHYSICIAN CORPORATION
Practice address
1245 S Mill St
Nashville, IL 62263-2004
Phone
(618) 327-9333
Fax
(618) 327-9022
NPI assigned
Sep 15, 2005
Last updated
Apr 27, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 27, 2009

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

Authorized official

Name
Debbie T Brewer
Title
Director of Provider Enrollment
Phone
(615) 465-7626

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X IL Primary
Physician Assistant 363A00000X IL

Addresses

Primary practice location

1245 S Mill St
Nashville, IL 62263-2004

Mailing address

7100 Commerce Way
Suite 180
Brentwood, TN 37027-2829

Other identifiers 1

IdentifierTypeStateIssuer
036052179MedicaidIL

National Provider Directory

National Provider Directory

Locations

1409 N Main St
Benton, IL 62812
Phone (618) 435-2712

202 Public Sq
Benton, IL 62812
Phone (618) 439-6370

302 N Main St
Ste A
Benton, IL 62812
Phone (618) 439-6470

213 NW 10th St
Ste E
Fairfield, IL 62837
Phone (618) 244-6710

208 S Washington St
Mc Leansboro, IL 62859
Phone (618) 643-2835

611 S Marshall Ave
Mc Leansboro, IL 62859
Phone (618) 542-2146

209 Crossroads Pl
Ste 110
Mount Vernon, IL 62864
Phone (618) 244-6710

606 E IL Highway 15
Mount Vernon, IL 62864
Phone (618) 241-7039

1245 S Mill St
Nashville, IL 62263
Phone (618) 327-8119

1472 W Saint Louis St
Nashville, IL 62263
Phone (618) 327-9333

267 E Saint Louis St
Nashville, IL 62263
Phone (618) 244-0031

205 E Belleville St
Okawville, IL 62271
Phone (618) 243-2061

Practitioners & affiliated clinicians

Practitioners 12

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.

NPI Registry JSON

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

{
    "created_epoch": "1126742400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1240790400000",
    "number": "1629063698",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7100 COMMERCE WAY",
            "address_2": "SUITE 180",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370272829"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1245 S MILL ST",
            "city": "NASHVILLE",
            "state": "IL",
            "postal_code": "622632004",
            "telephone_number": "618-327-9333",
            "fax_number": "618-327-9022"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CROSSROADS PHYSICIAN CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-15",
        "last_updated": "2009-04-27",
        "status": "A",
        "authorized_official_last_name": "BREWER",
        "authorized_official_first_name": "DEBBIE",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "DIRECTOR OF PROVIDER ENROLLMENT",
        "authorized_official_telephone_number": "615-465-7626"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": null,
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036052179",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Nashville, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2009; 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.