NPIMap

Organization Active NPI

Deaconess Illinois Specialty Clinic, Inc.

  • Family Medicine Physician
  • Mount Vernon, IL
National Provider Identifier
1841907409
Registry record updated Dec 2, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
DEACONESS ILLINOIS SPECIALTY CLINIC, INC.
Practice address
1 Good Samaritan Way
Mount Vernon, IL 62864-2402
Phone
(618) 242-4600
NPI assigned
Nov 3, 2022
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Kyle Dillman
Title
Secretary Treasurer
Phone
(812) 450-7399

National Provider Directory

National Provider Directory
Tax ID family
Deaconess Illinois Specialty Clinic Inc19 organizations share this tax ID, including this one

Other organizations with this tax ID 18

Organizations that report the same tax identification number in the National Provider Directory.

View all 18

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

NPPES NPI Registry

Primary practice location

1 Good Samaritan Way
Mount Vernon, IL 62864-2402

Mailing address

PO Box 34266
Belfast, ME 04915-0620
Phone (812) 450-6815

Other names 1

NPPES NPI Registry
  • Deaconess IL Specialty Good Samaritan Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Dec 2, 2022.

{
    "created_epoch": "1667433600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1669939200000",
    "number": "1841907409",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 34266",
            "city": "BELFAST",
            "state": "ME",
            "postal_code": "049150620",
            "telephone_number": "812-450-6815",
            "fax_number": "812-450-6822"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 GOOD SAMARITAN WAY",
            "city": "MOUNT VERNON",
            "state": "IL",
            "postal_code": "628642402",
            "telephone_number": "618-242-4600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEACONESS ILLINOIS SPECIALTY CLINIC, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-11-03",
        "last_updated": "2022-12-02",
        "certification_date": "2022-12-02",
        "status": "A",
        "authorized_official_last_name": "DILLMAN",
        "authorized_official_first_name": "KYLE",
        "authorized_official_title_or_position": "SECRETARY TREASURER",
        "authorized_official_telephone_number": "812-450-7399"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Deaconess IL Specialty Good Samaritan",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mount Vernon, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2022; 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.