Market Street Medical, LLC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

License

209012101 Issued in IL

Legal business name

MARKET STREET MEDICAL, LLC

Practice address

117 E Market St
Olney, IL 62450-2241

Phone

(618) 392-1301

NPI assigned

Nov 21, 2014

Organization subpart

No

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

Authorized official

Name

Kelly S. Eyer, FNP-BCNPI 1033516935

Title

Member

Phone

(618) 392-2395

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/10239/brand/1/csg/1/fhir/r4

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kelly S Eyer, FNP-BC

  • Family Nurse Practitioner
  • Olney, IL
  • NPI 1033516935
  Medicare reassignment NPD Authorized official
• Marlissa Boyles, FNP

  • Family Nurse Practitioner
  • Olney, IL
  • NPI 1316314933
  Medicare reassignment NPD
• Gail Greathouse, FNP

  • Family Nurse Practitioner
  • West Salem, IL
  • NPI 1215060298
  Medicare reassignment NPD

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

{
    "created_epoch": "1416528000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1416528000000",
    "number": "1831596733",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "117 E MARKET ST",
            "city": "OLNEY",
            "state": "IL",
            "postal_code": "624502241"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "117 E MARKET ST",
            "city": "OLNEY",
            "state": "IL",
            "postal_code": "624502241",
            "telephone_number": "618-392-1301"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARKET STREET MEDICAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-11-21",
        "last_updated": "2014-11-21",
        "status": "A",
        "authorized_official_last_name": "EYER",
        "authorized_official_first_name": "KELLY",
        "authorized_official_middle_name": "S.",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "618-392-2395",
        "authorized_official_credential": "FNP-BC"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "IL",
            "license": "209012101",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jamie L Long
• Cassie D Lynch, M.S., CCC-SLP
• Marion County Horizon Center
• Marion County Horizon Center D/B/a Richland Manor
• Marion Eye Centers LTD.
• Randall Ray Masterson, M.S., C.S.P.
• Pamela Matteson, AAS
• Jessica Lynn McCorvey, PMHNP-BC
• Madison Grace McCorvey
• Brandi McCracken

• Clinic/Center in Olney, IL
• Providers in Olney, IL by specialty
• Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.