NPIMap

Organization Active NPI

Charleston Primary Care Inc.

  • Primary Care Clinic/Center
  • Charleston, IL
National Provider Identifier
1770905952
Registry record updated Jan 7, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
CHARLESTON PRIMARY CARE INC.
Practice address
506 W Lincoln Ave
Suite 200
Charleston, IL 61920-2453
Phone
(217) 348-8730
Fax
(217) 345-7146
NPI assigned
Jan 7, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 7, 2014

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

Authorized official

Name
Danelle Jackson, MSN, APN, NP-C
Title
Owner
Phone
(217) 276-6421

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X Primary

Addresses

Primary practice location

506 W Lincoln Ave
Suite 200
Charleston, IL 61920-2453

Mailing address

506 W Lincoln Ave
Suite 200
Charleston, IL 61920-2453
Phone (217) 348-8730

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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": "1389052800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1389052800000",
    "number": "1770905952",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "506 W LINCOLN AVE",
            "address_2": "SUITE 200",
            "city": "CHARLESTON",
            "state": "IL",
            "postal_code": "619202453",
            "telephone_number": "217-348-8730",
            "fax_number": "217-345-7146"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "506 W LINCOLN AVE",
            "address_2": "SUITE 200",
            "city": "CHARLESTON",
            "state": "IL",
            "postal_code": "619202453",
            "telephone_number": "217-348-8730",
            "fax_number": "217-345-7146"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHARLESTON PRIMARY CARE INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-01-07",
        "last_updated": "2014-01-07",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "DANELLE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "217-276-6421",
        "authorized_official_credential": "MSN, APN, NP-C"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Charleston, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2014; 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.