NPIMap

Organization Active NPI

Greenville Rehab & Pain Clinic SC

  • Chiropractor
  • Greenville, IL
National Provider Identifier
1629197066
Registry record updated Mar 9, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
042.618745 Issued in IL
Legal business name
GREENVILLE REHAB & PAIN CLINIC SC
Practice address
1105 E Harris Ave
Greenville, IL 62246-2221
Phone
(618) 664-4600
Fax
(618) 664-2136
NPI assigned
Mar 28, 2007
Last updated
Mar 9, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 9, 2009

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

Authorized official

Name
Dr. Matthew Ray Chenault, D. C.NPI 1215027438
Title
Owner
Phone
(618) 664-4600

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 042.618745 IL Primary
Physical Therapist 225100000X 042618745 IL

Addresses

Primary practice location

1105 E Harris Ave
Greenville, IL 62246-2221

Mailing address

1105 E Harris Ave
Greenville, IL 62246-2221
Phone (618) 664-4600

Other identifiers 1

IdentifierTypeStateIssuer
0332010OtherILBCBS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060301000450 IL Part B Supplier - Clinic/Group Practice 9830105774 Receives reassigned benefits from 3 practitioners
1 other NPI on this enrollment
Practice locations: Greenville, IL

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Carlyle Rehab Pain Clinic2 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.

Practitioners & affiliated clinicians

Practitioners 4

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": "1175040000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1236556800000",
    "number": "1629197066",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1105 E HARRIS AVE",
            "city": "GREENVILLE",
            "state": "IL",
            "postal_code": "622462221",
            "telephone_number": "618-664-4600",
            "fax_number": "618-664-2136"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1105 E HARRIS AVE",
            "city": "GREENVILLE",
            "state": "IL",
            "postal_code": "622462221",
            "telephone_number": "618-664-4600",
            "fax_number": "618-664-2136"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREENVILLE REHAB & PAIN CLINIC SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-28",
        "last_updated": "2009-03-09",
        "status": "A",
        "authorized_official_last_name": "CHENAULT",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_middle_name": "RAY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "618-664-4600",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D. C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "IL",
            "license": "042.618745",
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IL",
            "license": "042618745",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "0332010",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Greenville, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.