Active NPI
Philip Frank Zumwalt, M.D.
- Family Medicine Physician
- Watseka, IL
National Provider Identifier
1629066170
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 036054820
- Practice address
- 125 S 4TH St
Watseka, IL 60970-1673 - Phone
- (815) 432-5430
- Fax
- (815) 432-6024
- NPI assigned
- Oct 10, 2005
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 036054820 | IL | Primary |
Addresses
Primary practice location
125 S 4TH St
Watseka, IL 60970-1673
Mailing address
125 S 4TH St
Watseka, IL 60970-1673
Phone (815) 432-5430
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 036054820 | Medicaid | IL | |
| 143939 | Other | IL | RURAL HEALTH CLINIC ID# |
| 371163481 | Other | IL | FED TAX ID # |
| 3800066 | Other | IL | BC/BS ID# |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Philip Zumwalt,M.D. | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Rural Health Clinic/Center
- Watseka, IL
- NPI 1508946112
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1128902400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1414972800000",
"number": "1629066170",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "125 S 4TH ST",
"city": "WATSEKA",
"state": "IL",
"postal_code": "609701673",
"telephone_number": "815-432-5430",
"fax_number": "815-432-6024"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "125 S 4TH ST",
"city": "WATSEKA",
"state": "IL",
"postal_code": "609701673",
"telephone_number": "815-432-5430",
"fax_number": "815-432-6024"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ZUMWALT",
"first_name": "PHILIP",
"middle_name": "FRANK",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-10-10",
"last_updated": "2014-11-03",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "IL",
"license": "036054820",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "036054820",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RURAL HEALTH CLINIC ID#",
"identifier": "143939",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FED TAX ID #",
"identifier": "371163481",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BC/BS ID#",
"identifier": "3800066",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Watseka, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.