NPIMap

Individual provider Active NPI

Clyde Grady

  • Family Medicine Physician
  • Knoxville, IL
National Provider Identifier
1851484075
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Practice address
104 S Broad St
Knoxville, IL 61448-1339
Phone
(309) 289-2335
Fax
(309) 289-8196
NPI assigned
Oct 2, 2006
Sex
Male
Sole proprietor
No

Organizations & group practices 13

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Southern Illinois University School of Medicine, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Southeast Iowa Regional Medical Center Inc 259 clinicians

Practice addresses (Care Compare)

1221 S Gear Ave
West Burlignton, IA 52655-1679
Phone (319) 768-1000

1225 S Gear Ave
West Burlington, IA 52655-1686

5445 Ave O
Fort Madison, IA 52627-9611
Phone (319) 376-2134

Hospital & facility affiliations

  • Southeast Iowa Regional Home Health Home health agency, West Burlington, IA, CCN 167136
  • Southeast Iowa Regional Hospice Hospice, West Burlington, IA, CCN 161567
  • Southeast Iowa Regional Medical Center Hospital, West Burlington, IA, CCN 160057
  • St Mary Medical Center Hospital, Galesburg, IL, CCN 140064
  • Henry County Health Center Hospital, Mount Pleasant, IA, CCN 161356
  • Oakview Nursing and Rehabilitation Nursing home, Burlington, IA, CCN 165439

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal or shaving of skin growth1-10
Skin biopsy1-10

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL, IA2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

All facility ownership & control disclosures 2

Medicare enrollment files

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Osf Healthcare - Medical Group - AbingdonAbingdon, IL, CCN 148638 Rural health clinic Contracted Managing Employee
Operational/Managerial Control		 Dec 1, 2022
Dec 1, 2022
Osf Healthcare - Medical Group - KnoxvilleKnoxville, IL, CCN 148648 Rural health clinic Contracted Managing Employee
Operational/Managerial Control		 Dec 1, 2022
Dec 1, 2022

Medicare enrollment records 2

Medicare enrollment files
Enrollment IDStateProvider typePAC IDDetails
I20100521000651 IL Practitioner - Family Practice 9335278886 Reassigns benefits to 3 organizations
I20240124000593 IA Practitioner - Family Practice 9335278886 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
Flagged The directory lists this NPI on an HHS exclusion list. Confirm with the OIG exclusions search.
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
036-096795ILMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Southeast Iowa Regional Medical Center, Inc. CurrentSince Jan 1, 2024 Accepting new patients
St Mary Medical Center Current Accepting new patients
Central PA Pharmacy LLC. Current Accepting new patients
St Mary Medical Center CurrentSince Dec 1, 2022 Accepting new patients
Osf Multi-Specialty Group CurrentSince Jan 1, 2016 Accepting new patients
St Mary Medical Center Family Medicine CurrentSince Dec 1, 2022 Accepting new patients
Osf Healthcare System Current Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients

Locations

1221 S Gear Ave
West Burlington, IA 52655
Phone (319) 768-3622

1225 S Gear Ave
Ste 159
West Burlington, IA 52655
Phone (319) 752-4553

1201 W Agency Rd
West Burlington, IA 52655
Phone (319) 394-3991

3375 N Seminary St
Galesburg, IL 61401
Phone (309) 343-5114

3315 N Seminary St
Galesburg, IL 61401
Phone (309) 344-1000

230 S Exchange St
Galva, IL 61434
Phone (309) 932-3800

104 S Broad St
Knoxville, IL 61448
Phone (309) 289-2335

1000 W Harlem Ave
Monmouth, IL 61462
Phone (309) 734-1414

8600 State Route 91
Ste 130
Peoria, IL 61615
Phone (309) 683-5050

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X IL Primary

Addresses

NPPES NPI Registry

Primary practice location

104 S Broad St
Knoxville, IL 61448-1339

Mailing address

104 S Broad St
Knoxville, IL 61448-1339
Phone (309) 289-2335

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jul 8, 2007.

{
    "created_epoch": "1159747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1851484075",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "104 S BROAD ST",
            "city": "KNOXVILLE",
            "state": "IL",
            "postal_code": "614481339",
            "telephone_number": "309-289-2335",
            "fax_number": "309-289-8196"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 S BROAD ST",
            "city": "KNOXVILLE",
            "state": "IL",
            "postal_code": "614481339",
            "telephone_number": "309-289-2335",
            "fax_number": "309-289-8196"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRADY",
        "first_name": "CLYDE",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-02",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Knoxville, IL

Sources for this page

Verify at the official NPI Registry.