NPIMap

Organization Active NPI

Family Practice Medical Center LTD

  • Rural Health Clinic/Center
  • Danville, IL
National Provider Identifier
1659312072
Registry record updated Apr 25, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
036087566 Issued in IL
Legal business name
FAMILY PRACTICE MEDICAL CENTER LTD
Practice address
511 W Fairchild St
Danville, IL 61832-3801
Phone
(217) 431-2025
Fax
(217) 431-0014
NPI assigned
Jun 9, 2006
Reactivated
Oct 23, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 25, 2013

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

Authorized official

Name
Dr. George R Gindi, MDNPI 1477503472
Title
Owner
Phone
(217) 431-2025

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
Rural Health Clinic/Center 261QR1300X 036087566 IL Primary
Rural Health Clinic/Center 261QR1300X 036100736 IL

Addresses

Primary practice location

511 W Fairchild St
Danville, IL 61832-3801

Mailing address

511 W Fairchild St
Danville, IL 61832-3801
Phone (217) 431-2025

Other identifiers 4

IdentifierTypeStateIssuer
015566OtherILHEALTH ALLIANCE
036100736MedicaidIL
036087566MedicaidIL
09232019OtherILBLUE CROSS BLUE SHIELD

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031217000722 IL Part A Provider - Rural Health Clinic 6103723184 Practice locations: Danville, IL

Rural health clinic certification: CCN 148956

Legal name
FAMILY PRACTICE MEDICAL CENTER LTD
Doing business as
FAMILY PRACTICE MEDICAL CENTER LTD
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Mar 18, 2004
Last certification
Feb 9, 2024
Ownership / control type
1B
Organization structure
CorporationProprietary
Incorporated
Dec 5, 2000 in IL
Enrollment address
511 W Fairchild St
Danville, IL 61832-3801

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Family Practice Medical Ctr3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Ownership & related parties

All disclosed owners & managing parties 4

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
George R Gindi Individual 5% Or Greater Direct Ownership Interest Dec 5, 2000 100%
Corporate Director Dec 5, 2000
Family Practice Medical Center LTD Organization, Danville, IL Medical provider/supplier 5% Or Greater Direct Ownership Interest Jan 1, 2001
Mary Y Gindi Individual Corporate Officer Dec 12, 2001
Melbo Yostos Individual W-2 Managing Employee Mar 1, 2012

Owners & managing parties with NPI records 3

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1149811200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1366848000000",
    "number": "1659312072",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "511 W FAIRCHILD ST",
            "city": "DANVILLE",
            "state": "IL",
            "postal_code": "618323801",
            "telephone_number": "217-431-2025",
            "fax_number": "217-431-0014"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "511 W FAIRCHILD ST",
            "city": "DANVILLE",
            "state": "IL",
            "postal_code": "618323801",
            "telephone_number": "217-431-2025",
            "fax_number": "217-431-0014"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY PRACTICE MEDICAL CENTER LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-09",
        "last_updated": "2013-04-25",
        "deactivation_date": "2008-06-10",
        "reactivation_date": "2009-10-23",
        "status": "A",
        "authorized_official_last_name": "GINDI",
        "authorized_official_first_name": "GEORGE",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "217-431-2025",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "IL",
            "license": "036087566",
            "primary": true
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "IL",
            "license": "036100736",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH ALLIANCE",
            "identifier": "015566",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036100736",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036087566",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "09232019",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Danville, IL

Sources for this page

Verify at the official NPI Registry.