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

Doing business as

UltiMed Plus

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

Last updated

Feb 12, 2016By the provider in NPPES

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, and the practitioner matching its NPPES authorized official.

• Charles W Neal, M.D.

  • Family Medicine Physician
  • Mount Vernon, IL
  • NPI 1053380683
  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": "",
            "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 (MedicOne Medical Response)
• Heartland Radiology Associates LTD
• Heartland Women's Healthcare, LTD (Heartland Women's Healthcare)
• Morgan Lynn Virginia Henry
• Elizabeth A Hensley, M.S., L.C.P.C.
• Sara Elizabeth Hensley, PHARMD.

• Family Medicine Physician in Mount Vernon, IL
• Providers in Mount Vernon, IL by specialty
• 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.