NPIMap

Organization Active NPI

Medical Associates of Jerseyville, LTD.

  • Family Medicine Physician
  • Jerseyville, IL
National Provider Identifier
1750353454
Registry record updated Apr 24, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
MEDICAL ASSOCIATES OF JERSEYVILLE, LTD.
Practice address
270 Maple Summit Rd
McDow Building
Jerseyville, IL 62052-2004
Phone
(618) 498-7108
Fax
(618) 498-7919
NPI assigned
Feb 6, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 24, 2008

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

Authorized official

Name
Mrs. Terry Lynn Benware, R.N.
Title
Practice Manager
Phone
(618) 498-7108

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X
Rural Health Clinic/Center 261QR1300X

Addresses

Primary practice location

270 Maple Summit Rd
McDow Building
Jerseyville, IL 62052-2004

Mailing address

PO Box 364
Jerseyville, IL 62052-0364
Phone (618) 498-7108

Other identifiers 1

IdentifierTypeStateIssuer
042007207OtherILCORPORATE LICENSE

National Provider Directory

National Provider Directory

Locations

113 E Main St
Grafton, IL 62037
Phone (618) 786-2380

Practitioners & affiliated clinicians

Practitioners 2

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

NPI Registry JSON

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

{
    "created_epoch": "1139184000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208995200000",
    "number": "1750353454",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 364",
            "city": "JERSEYVILLE",
            "state": "IL",
            "postal_code": "620520364",
            "telephone_number": "618-498-7108",
            "fax_number": "618-498-7919"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "270 MAPLE SUMMIT RD",
            "address_2": "MCDOW BUILDING",
            "city": "JERSEYVILLE",
            "state": "IL",
            "postal_code": "620522004",
            "telephone_number": "618-498-7108",
            "fax_number": "618-498-7919"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICAL ASSOCIATES OF JERSEYVILLE, LTD.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-06",
        "last_updated": "2008-04-24",
        "status": "A",
        "authorized_official_last_name": "BENWARE",
        "authorized_official_first_name": "TERRY",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "618-498-7108",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "R.N."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CORPORATE LICENSE",
            "identifier": "042007207",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jerseyville, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2008; 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.