Integrative Performance Medical Group, PLLC

Primary specialty

SpecialistTaxonomy code 174400000X

Legal business name

INTEGRATIVE PERFORMANCE MEDICAL GROUP, PLLC

Practice address

200 S Buchanan St
Edwardsville, IL 62025-2109

Phone

(618) 659-8889

Fax

(618) 283-1101

NPI assigned

Feb 26, 2019

Organization subpart

No

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

Authorized official

Name

Jessica Buatte

Title

Office Manager

Phone

(618) 659-8889

Specialties & licenses 2

Addresses

Locations

Practitioners 1

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

• Emily J Odom, D.C.

  • Chiropractor
  • Lebanon, IL
  • NPI 1275990780
  NPD (past)

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

{
    "created_epoch": "1551139200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1551139200000",
    "number": "1699232637",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 S BUCHANAN ST",
            "city": "EDWARDSVILLE",
            "state": "IL",
            "postal_code": "620252109",
            "telephone_number": "618-659-8889",
            "fax_number": "618-283-1101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 S BUCHANAN ST",
            "city": "EDWARDSVILLE",
            "state": "IL",
            "postal_code": "620252109",
            "telephone_number": "618-659-8889",
            "fax_number": "618-283-1101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTEGRATIVE PERFORMANCE MEDICAL GROUP, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-02-26",
        "last_updated": "2019-02-26",
        "status": "A",
        "authorized_official_last_name": "BUATTE",
        "authorized_official_first_name": "JESSICA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "618-659-8889"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jeannette Ineza
• Integrated Medical Group
• Integrated Medical Group LTD
• Integrated Medical Group LTD
• Integrated Medical Group, LTD
• Integrity Nurse Staffing
• Intensive Out-Patient Care
• Intensive Out-Patient Care
• Interfaith Counseling Center
• Malina Lynn Isaak

• Specialist in Edwardsville, IL
• Providers in Edwardsville, IL by specialty
• Specialist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2019; 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.