Heartland Occupational Medicine Physicians of Illinois S C

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

036079719 Issued in IL

Legal business name

HEARTLAND OCCUPATIONAL MEDICINE PHYSICIANS OF ILLINOIS S C

Practice address

4117 S Water Tower PL
Suite D
Mount Vernon, IL 62864-6293

Phone

(618) 242-4848

Fax

(618) 242-4198

NPI assigned

Mar 14, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Charles W Neal, M.D.NPI 1053380683

Title

President

Phone

(618) 242-4848

Specialties & licenses 1

Addresses

Other names 1

• UltiMed Plus Doing business as

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Locations

Practitioners 4

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

• Charles W Neal, M.D.

  • Family Medicine Physician
  • Mount Vernon, IL
  • NPI 1053380683

  IL

  Medicare reassignment Authorized official
• Agnes Boehning, APN-FNP

  • Family Nurse Practitioner
  • Centralia, IL
  • NPI 1821134115
  NPD (past)
• Tracy L Thompson, PA-C

  • Physician Assistant
  • Benton, IL
  • NPI 1407616303
  NPD (past)
• Alicia Yaeger, FNP, PMHNP, FPA

  • Psychiatric/Mental Health Nurse Practitioner
  • Centralia, IL
  • NPI 1861911026
  NPD (past)

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

{
    "created_epoch": "1142294400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1455235200000",
    "number": "1720057730",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4117 S WATER TOWER PL",
            "address_2": "SUITE D",
            "city": "MOUNT VERNON",
            "state": "IL",
            "postal_code": "628646293",
            "telephone_number": "618-242-4848",
            "fax_number": "618-242-4198"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4117 S WATER TOWER PL",
            "address_2": "SUITE D",
            "city": "MOUNT VERNON",
            "state": "IL",
            "postal_code": "628646293",
            "telephone_number": "618-242-4848",
            "fax_number": "618-242-4198"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEARTLAND OCCUPATIONAL MEDICINE PHYSICIANS OF ILLINOIS S C",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-14",
        "last_updated": "2016-02-12",
        "status": "A",
        "authorized_official_last_name": "NEAL",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "618-242-4848",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036079719",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "UltiMed Plus",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Amanda Lynn Hays, LPN
• Jon Riley Hays, MD
• Lisa Ellen Hayse, MHP
• Healing Hands Chiropractic, PC
• Healthone Critical Care Transport Services Inc
• Heartland Radiology Associates LTD
• Heartland Women'S Healthcare, LTD
• Morgan Lynn Virginia Henry
• Elizabeth A Hensley, M.S., L.C.P.C.
• Sara Elizabeth Hensley, PHARMD.

• All providers in Mount Vernon, IL
• Family Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2016; 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.