Active NPI
David J Greathouse, D.O.
- Internal Medicine Physician
- Macomb, IL
National Provider Identifier
1720071129
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 036078513
- Practice address
- 5 Doctors LN
Macomb, IL 61455-3369 - Phone
- (309) 836-3387
- Fax
- (309) 833-1023
- NPI assigned
- Aug 31, 2005
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 036078513 | IL | Primary |
Addresses
Primary practice location
5 Doctors LN
Macomb, IL 61455-3369
Mailing address
5 Doctors LN
Macomb, IL 61455-3369
Phone (309) 836-3387
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 036078513 | Medicaid | IL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036078513 | IL | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Gastrohealth of Illinois SC | Current | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Specialist
- Macomb, IL
- NPI 1114326204
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1125446400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1280707200000",
"number": "1720071129",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5 DOCTORS LN",
"city": "MACOMB",
"state": "IL",
"postal_code": "614553369",
"telephone_number": "309-836-3387",
"fax_number": "309-833-1023"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5 DOCTORS LN",
"city": "MACOMB",
"state": "IL",
"postal_code": "614553369",
"telephone_number": "309-836-3387",
"fax_number": "309-833-1023"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GREATHOUSE",
"first_name": "DAVID",
"middle_name": "J",
"credential": "D.O.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-08-31",
"last_updated": "2010-08-02",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "IL",
"license": "036078513",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "036078513",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Macomb, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.