NPIMap

Organization Active NPI

Midwest Inpatient Anderson Health, Inc

  • Emergency Medicine Physician
  • Maryville, IL
National Provider Identifier
1821758608
Registry record updated Dec 21, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
Legal business name
MIDWEST INPATIENT ANDERSON HEALTH, INC
Practice address
6800 Il 162
Maryville, IL 62062
Phone
(618) 288-5711
NPI assigned
Dec 21, 2021
Last updated
Dec 21, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 21, 2021

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

Authorized official

Name
Carmon L Glover III, DONPI 1497701510
Title
Owner/President
Phone
(618) 206-3313

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X NU Primary

Addresses

Primary practice location

6800 Il 162
Maryville, IL 62062

Mailing address

320 E Highway 50
O Fallon, IL 62269-2704
Phone (618) 206-3313

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220322002045 IL Part B Supplier - Clinic/Group Practice 3072908474 Receives reassigned benefits from 135 practitioners
Practice locations: Maryville, IL; Staunton, IL

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 136

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 136

NPI Registry JSON

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

{
    "created_epoch": "1640044800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1640044800000",
    "number": "1821758608",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "320 E HIGHWAY 50",
            "city": "O FALLON",
            "state": "IL",
            "postal_code": "622692704",
            "telephone_number": "618-206-3313"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6800 IL 162",
            "city": "MARYVILLE",
            "state": "IL",
            "postal_code": "62062",
            "telephone_number": "618-288-5711"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIDWEST INPATIENT ANDERSON HEALTH, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-12-21",
        "last_updated": "2021-12-21",
        "certification_date": "2021-12-20",
        "status": "A",
        "authorized_official_last_name": "GLOVER",
        "authorized_official_first_name": "CARMON",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "618-206-3313",
        "authorized_official_name_suffix": "III",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Maryville, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.