NPIMap

Individual provider Active NPI

Patrick Barry Renick, MD

  • Family Medicine Physician
  • Canton, IL
National Provider Identifier
1760604193
Registry record updated Apr 13, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
036119167 Issued in IL
Practice address
180 S Main St
Canton, IL 61520-2608
Phone
(309) 647-0201
Fax
(309) 649-6880
NPI assigned
May 3, 2007
Last updated
Apr 13, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 13, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 036119167 IL Primary

Addresses

Primary practice location

180 S Main St
Canton, IL 61520-2608

Mailing address

180 S Main St
Canton, IL 61520-2608
Phone (309) 647-0201

Other identifiers 1

IdentifierTypeStateIssuer
036119167MedicaidIL

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address patrick.renick@gmgil.eclinicaldirectplus.com Health Information Exchange (HIE) Graham Hospital Association

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080429000569 IL Practitioner - Family PracticePractitioner - Emergency Medicine 7416035605 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family PracticeAlso: Emergency Medicine
Education
Saint Louis University School of Medicine, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Graham Hospital AssociationGroup PAC ID 2769375021, 124 clinicians
Advanced Physical Therapy Services, LTD.Group PAC ID 9133101462, shared by 5 NPIs, 216 clinicians
Carle Health Care IncorporatedGroup PAC ID 3577515774, 1,592 clinicians

Practice addresses (Care Compare)

180 S Main St
Canton, IL 61520-2608
Phone (309) 647-0201

61 E Side SQ
Canton, IL 61520-2603
Phone (309) 649-1572

611 W Park St
Urbana, IL 61801-2501
Phone (888) 712-2753

815 Main St
Suite a
Peoria, IL 61602-1080
Phone (309) 672-4977

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
83.26 of 100Reported as group
Quality
62.57
Promoting interoperability
100
Improvement activities
40
Cost
77.37

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
036119167ILMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Carle Health Medical Group Family Medicine CurrentSince Jan 1, 2026 Accepting new patients
Methodist Medical Center of Illinois CurrentSince Jan 4, 2008 Accepting new patients
Methodist Medical Center of Illinois Family Medicine CurrentSince Jan 4, 2008 Accepting new patients
Graham Hospital Association CurrentSince Jul 16, 2008 Accepting new patients
Graham Hospital Association CurrentSince Jul 16, 2008 Accepting new patients
Methodist Medical Center of Illinois Current Accepting new patients

Locations

175 S Main St
Canton, IL 61520
Phone (309) 647-3937

180 S Main St
Canton, IL 61520
Phone (309) 647-5240

210 W Walnut St
Canton, IL 61520
Phone (309) 647-5240

221 NE Glen Oak Ave
Peoria, IL 61636
Phone (309) 672-4281

815 Main St
Ste A
Peoria, IL 61602
Phone (309) 671-3000

611 W Park St
Urbana, IL 61801
Phone (217) 383-6941

Interoperability endpoints

  • Direct secure messaging: patrick.renick@gmgil.eclinicaldirectplus.com

Ownership & related parties

All facility ownership & control disclosures 5

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

FacilityTypeRoleSince
Graham Medical Group-CantonCanton, IL, CCN 143492 Rural health clinic Corporate Director Jan 1, 2019
Graham Medical Group FarmingtonFarmington, IL, CCN 143494 Rural health clinic Corporate Director Jan 1, 2019
Graham Medical Group ElmwoodElmwood, IL, CCN 148603 Rural health clinic Corporate Officer
Operational/Managerial Control		 Mar 4, 2019
Mar 4, 2019
Galesburg-Knoxville Graham Medical GroupGalesburg, IL, CCN 148659 Rural health clinic Corporate Director Jan 1, 2021
Graham Medical Group-WilliamsfieldWilliamsfield, IL, CCN 148636 Rural health clinic Corporate Director Jan 1, 2019

Owned or controlled facilities with NPI records 6

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

Organizations & group practices 6

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.

Hospital & facility affiliations 9

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

NPI Registry JSON

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

{
    "created_epoch": "1178150400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1618272000000",
    "number": "1760604193",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "180 S MAIN ST",
            "city": "CANTON",
            "state": "IL",
            "postal_code": "615202608",
            "telephone_number": "309-647-0201",
            "fax_number": "309-649-5101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "180 S MAIN ST",
            "city": "CANTON",
            "state": "IL",
            "postal_code": "615202608",
            "telephone_number": "309-647-0201",
            "fax_number": "309-649-6880"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RENICK",
        "first_name": "PATRICK",
        "middle_name": "BARRY",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-03",
        "last_updated": "2021-04-13",
        "certification_date": "2021-04-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036119167",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036119167",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "patrick.renick@gmgil.eclinicaldirectplus.com",
            "affiliation": "Y",
            "affiliationName": "Graham Hospital Association",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "180 S Main St",
            "city": "Canton",
            "state": "IL",
            "country_code": "US",
            "postal_code": "615202608",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Canton, IL

Sources for this page

Verify at the official NPI Registry.