Mid America Radiology SC

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

Legal business name

MID AMERICA RADIOLOGY SC

Practice address

1 Good Samaritan Way
Radiology Dept
Mount Vernon, IL 62864-2402

Phone

(618) 242-4600

NPI assigned

May 23, 2006

Organization subpart

No

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

Authorized official

Name

Jerrold C Willis, MD

Title

President

Phone

(618) 242-4600

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1148342400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1615766400000",
    "number": "1770538282",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2153 DEPT 20002",
            "city": "BIRMINGHAM",
            "state": "AL",
            "postal_code": "352870001",
            "telephone_number": "303-465-0401",
            "fax_number": "303-438-1351"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 GOOD SAMARITAN WAY",
            "address_2": "RADIOLOGY DEPT",
            "city": "MOUNT VERNON",
            "state": "IL",
            "postal_code": "628642402",
            "telephone_number": "618-242-4600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MID AMERICA RADIOLOGY SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-23",
        "last_updated": "2021-03-15",
        "certification_date": "2021-03-15",
        "status": "A",
        "authorized_official_last_name": "WILLIS",
        "authorized_official_first_name": "JERROLD",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "618-242-4600",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR/ GOOD SAM & ST MARY'S",
            "identifier": "CB6407",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR/ ST JOE & UTLAH",
            "identifier": "CB6408",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Doris Meadows, RNFA
• Allie McKenzie Melvin, COTA
• Ashley Ann Melvin, MHP
• Teresa L Mendenhall, RN
• Kinny Merchant, OT
• Midwest Emergency Good Samaritan
• Midwest Emergency Good Samaritan, Inc
• Midwest Endoscopy Associates, PLLC
• Midwest Medical and Occupational Services SC
• Midwest Sinus Sleep & Allergy Associates, LLC

• Diagnostic Radiology Physician in Mount Vernon, IL
• Providers in Mount Vernon, IL by specialty
• Diagnostic Radiology Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2021; 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.