NPIMap

Organization Active NPI

St Elizabeths Hospital of the Hospital Sisters of the Third Order

Doing business as Occupational Medicine

  • Occupational Medicine Physician
  • Belleville, IL
National Provider Identifier
1679789481
Registry record updated Oct 31, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational Medicine PhysicianTaxonomy code 2083X0100X
Legal business name
ST ELIZABETHS HOSPITAL OF THE HOSPITAL SISTERS OF THE THIRD ORDER
Doing business as
Occupational Medicine
Practice address
301 W Lincoln St
Suite 100
Belleville, IL 62220-1901
Phone
(618) 234-2120
Fax
(618) 234-1773
NPI assigned
May 16, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 31, 2024

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

Authorized official

Name
Mark D Evard
Title
VP of Revenue Cycle
Phone
(217) 492-9651

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2083X0100X IL Primary

Addresses

Primary practice location

301 W Lincoln St
Suite 100
Belleville, IL 62220-1901

Mailing address

3051 Hollis Dr
Springfield, IL 62704-7450
Phone (618) 234-2120

Other names 1

  • Occupational Medicine Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address hshs_st_elizabeth_ofallon2202617@ewd.direct.hshs.org Direct

National Provider Directory

National Provider Directory
Tax ID family
St Elizabeth Hospital8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

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

Locations

301 W Lincoln St
Ste 100
Belleville, IL 62220

NPI Registry JSON

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

{
    "created_epoch": "1179273600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730332800000",
    "number": "1679789481",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3051 HOLLIS DR",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627047450",
            "telephone_number": "618-234-2120",
            "fax_number": "618-234-1773"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 W LINCOLN ST",
            "address_2": "SUITE 100",
            "city": "BELLEVILLE",
            "state": "IL",
            "postal_code": "622201901",
            "telephone_number": "618-234-2120",
            "fax_number": "618-234-1773"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST ELIZABETHS HOSPITAL OF THE HOSPITAL SISTERS OF THE THIRD ORDER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-16",
        "last_updated": "2024-10-31",
        "certification_date": "2024-10-31",
        "status": "A",
        "authorized_official_last_name": "EVARD",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "VP OF REVENUE CYCLE",
        "authorized_official_telephone_number": "217-492-9651"
    },
    "taxonomies": [
        {
            "code": "2083X0100X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Preventive Medicine, Occupational Medicine",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "hshs_st_elizabeth_ofallon2202617@ewd.direct.hshs.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/CCD/TXT",
            "address_1": "1 Saint Elizabeth Blvd",
            "city": "O Fallon",
            "state": "IL",
            "country_code": "US",
            "postal_code": "622691099",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Occupational Medicine",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Occupational Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Belleville, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2024; 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.