Stonewall McCuiston Jr., MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

036074737 Issued in IL

Practice address

375 N Wall St Ste P310
Kankakee, IL 60901-3484

Phone

(815) 933-0194

Fax

(815) 936-3847

NPI assigned

Aug 31, 2005

Last updated

Mar 29, 2021By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Internal MedicineAlso: Pediatric Medicine

Education

Meharry Medical College School of Medicine, 1985

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Riverside Health SystemGroup PAC ID 3274434717, 202 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• R.M.C. Home Health Care Home health agency, Peotone, IL, CCN 147400
• Uplifted Care Hospice, Bourbonnais, IL, CCN 141556
• Riverside Medical Center Hospital, Kankakee, IL, CCN 140186

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: smccuiston7453@direct.riversidehealthcare.net

All facility ownership & control disclosures 6

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

Owned or controlled facilities with NPI records 5

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

• Hospice of Kankakee Valley, Inc.

  • Community Based Hospice Care Agency
  • Bourbonnais, IL
  • NPI 1811935240

  Corporate Director

  CMS ownership
• Riverside Medical Center

  • General Acute Care Hospital
  • Kankakee, IL
  • NPI 1538208210

  Corporate Director

  CMS ownership
• Riverside Medical Center

  • Home Health Agency
  • Peotone, IL
  • NPI 1740346451

  Corporate Director

  CMS ownership
• Riverside Medical Center

  • Psychiatric Hospital Unit
  • Kankakee, IL
  • NPI 1982093837

  Corporate Director

  CMS ownership
• Riverside Medical Center

  dba Pembroke Community Health Center

  • Family Medicine Physician
  • Hopkins Park, IL
  • NPI 1982703005

  Corporate Director

  CMS ownership

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Riverside Health System

  • General Practice Physician
  • Kankakee, IL
  • NPI 1417061193
  Medicare reassignment Care Compare group NPD
• Riverside Medical Center

  dba Pembroke Community Health Center

  • Family Medicine Physician
  • Hopkins Park, IL
  • NPI 1982703005
  Medicare reassignment NPD
• Med-Peds Associates,P.C.

  • Pediatrics Physician
  • Kankakee, IL
  • NPI 1063538312

  Internal Medicine

  NPD (past) Authorized official
• Riverside Health System

  dba Psychiatric Associates

  • Psychiatry Physician
  • Kankakee, IL
  • NPI 1336354430
  NPD
• Riverside Medical Center

  • Home Health Agency
  • Peotone, IL
  • NPI 1740346451
  NPD
• Nexus Family Healing

  dba Nexus - Indian Oaks Academy

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Manteno, IL
  • NPI 1902855240
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Hospice of Kankakee Valley, Inc.

  • Community Based Hospice Care Agency
  • Bourbonnais, IL
  • NPI 1811935240
  Care Compare affiliation
• Riverside Medical Center

  • General Acute Care Hospital
  • Kankakee, IL
  • NPI 1538208210
  Care Compare affiliation
• Riverside Medical Center

  • Home Health Agency
  • Peotone, IL
  • NPI 1740346451
  Care Compare affiliation

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

{
    "created_epoch": "1125446400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616976000000",
    "number": "1720072143",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "375 N WALL ST STE P310",
            "city": "KANKAKEE",
            "state": "IL",
            "postal_code": "609013484",
            "telephone_number": "815-933-0194",
            "fax_number": "815-936-3847"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "375 N WALL ST STE P310",
            "city": "KANKAKEE",
            "state": "IL",
            "postal_code": "609013484",
            "telephone_number": "815-933-0194",
            "fax_number": "815-936-3847"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3400 S Main St",
            "address_purpose": "LOCATION",
            "city": "Hopkins Park",
            "state": "IL",
            "postal_code": "60944",
            "country_code": "US",
            "telephone_number": "815-944-5545",
            "fax_number": "815-944-6723",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MCCUISTON",
        "first_name": "STONEWALL",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-31",
        "last_updated": "2021-03-29",
        "certification_date": "2021-03-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036074737",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IL",
            "license": "036074737",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS AND BLUE SHIELD OF ILLINOIS",
            "identifier": "4623239",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036074737",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "smccuiston7453@Direct.riversidehealthcare.net",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "375 N Wall St Ste P310",
            "city": "Kankakee",
            "state": "IL",
            "country_code": "US",
            "postal_code": "609013484",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Anitra Ladawn Monique McCurry
• Kelly A McDonnell, RD
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• Pediatrics Physician in Kankakee, IL
• Providers in Kankakee, IL by specialty
• Pediatrics Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.