NPIMap

Organization Active NPI

Passavant Physician Association

Doing business as Passavant Internal Medicine Rural Health Clinic

  • Internal Medicine Physician
  • Jacksonville, IL
National Provider Identifier
1720370778
Registry record updated Jul 6, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
036091905 Issued in IL
Legal business name
PASSAVANT PHYSICIAN ASSOCIATION
Doing business as
Passavant Internal Medicine Rural Health Clinic
Practice address
559 N Westgate Ave
Jacksonville, IL 62650-1156
Phone
(217) 243-5474
NPI assigned
May 10, 2011
Last updated
Jul 6, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 6, 2011

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

Authorized official

Name
Mr. Stephen G Lee
Title
Manager
Phone
(217) 479-5890

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X 209004842 IL
Internal Medicine Physician 207R00000X 036056832 IL
Internal Medicine Physician 207R00000X 036091905 IL Primary

Addresses

Primary practice location

559 N Westgate Ave
Jacksonville, IL 62650-1156

Mailing address

1600 W Walnut St
Jacksonville, IL 62650-1136
Phone (217) 245-9541

Other names 1

  • Passavant Internal Medicine Rural Health Clinic Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Passavant Physician Association4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1304985600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1309910400000",
    "number": "1720370778",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1600 W WALNUT ST",
            "city": "JACKSONVILLE",
            "state": "IL",
            "postal_code": "626501136",
            "telephone_number": "217-245-9541"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "559 N WESTGATE AVE",
            "city": "JACKSONVILLE",
            "state": "IL",
            "postal_code": "626501156",
            "telephone_number": "217-243-5474"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PASSAVANT PHYSICIAN ASSOCIATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-05-10",
        "last_updated": "2011-07-06",
        "status": "A",
        "authorized_official_last_name": "LEE",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "217-479-5890",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "IL",
            "license": "209004842",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036056832",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036091905",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Passavant Internal Medicine Rural Health Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Jacksonville, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2011; 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.