Melanie L. Banal, NP-C
Individual provider Active NPI Nurse Practitioner · Breese, IL
NPI 1770986010 · NPPES record last updated Mar 22, 2022
Key facts
- NPI
- 1770986010
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Nurse Practitioner 363L00000X
- License
- 209011871 (IL)
- Practice address
- 14160 Jamestown Rd
Breese, IL 62230-3694 - Phone
- (618) 526-7154
- Fax
- (618) 526-8248
- NPI assigned
- Oct 1, 2014
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 5
Hospital & facility affiliations 5
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2014
- Medicare assignment
- May accept Medicare assignment
- Group practices
- Ahs Il Medical Group LLC
Practice addresses (Care Compare)
2044 Madison Ave
Granite City, IL 62040-4641
Phone (618) 451-1500
Hospital & facility affiliations
- Gateway Regional Medical Center
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160506001023 | IL | Practitioner - Nurse Practitioner | 2567684012 | Reassigns benefits to 4 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 209011871 | IL | MD | Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| McDonough County Hospital District | Current |
Accepting new patients | |
| McDonough County Hospital District | Current |
Accepting new patients | |
| Ahs Il Medical Group LLC | Current |
Accepting new patients | |
| McDonough County Hospital District | Current |
Accepting new patients | |
| Physicians Immediate Care North Chicago LLC | Current |
Accepting new patients |
Locations
1 Saint Anthonys Way
Alton, IL 62002
Phone (618) 233-6870
1150 N Cole St
Bushnell, IL 61422
Phone (309) 772-2255
4211 N Cicero Ave
Chicago, IL 60641
Phone (773) 794-1000
515 Belt Line Rd
Collinsville, IL 62234
Phone (618) 344-7882
4273 S State Route 159
Glen Carbon, IL 62034
Phone (618) 288-2297
2044 Madison Ave
Ste 27
Granite City, IL 62040
Phone (618) 451-0700
2044 Madison Ave
Ste 15
Granite City, IL 62040
Phone (618) 451-1500
2100 Madison Ave
Granite City, IL 62040
Phone (618) 798-3000
515 E Grant St
Ste 111
Macomb, IL 61455
Phone (309) 837-6937
503 E Grant St
Macomb, IL 61455
Phone (309) 833-5917
2 Americinn Way
Ste B
Monmouth, IL 61462
Phone (309) 715-7362
8 Doctors Park Rd
Mount Vernon, IL 62864
Phone (618) 244-5500
619 Edwardsville Rd
Troy, IL 62294
Phone (618) 667-1200
Interoperability endpoints
- melanie.banal.1@28328.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 209011871 | IL | Yes |
Addresses
Primary practice location
14160 Jamestown Rd
Breese, IL 62230-3694
Mailing address
14160 Jamestown Rd
Breese, IL 62230-3694
Phone (618) 526-7154
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | mbanal175892@ewd.direct.hshs.org | Direct |
Other providers in Breese, IL
- Stephanie Lynn Altizer
- Anxiety and Stress Relief Center PLLC
- Apex Physical Therapy, LLC.
- Clare R Arentsen
- Abigail Baker
- Regina M Bauer
- Timothy Manson Beaty
- Amy Becker
- Kari Bernice Becker
- Pamela N Benhoff
All providers in Breese, IL · Nurse Practitioner in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 22, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.