Proactive MD Il SC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

PROACTIVE MD IL SC

Doing business as

OE 520 Health Center

Practice address

1472 N Green Mount Rd
O Fallon, IL 62269-3416

Phone

(730) 240-8040

NPI assigned

Apr 7, 2025

Last updated

Aug 31, 2026By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mark Allen Kemble, MD

Title

Chief Medical Officer

Phone

(864) 640-8355

Specialties & licenses 1

Addresses

Other names 1

• OE 520 Health Center Doing business as

Tax ID family

Oe 520 Health Center3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

• Proactive MD Il SC

  dba PROACTIVE MD CFI Deerfield Health Center

  • Primary Care Clinic/Center
  • Deerfield, IL
  • NPI 1922759349
  NPD tax ID
• Proactive MD Il SC

  • Primary Care Clinic/Center
  • Greenville, SC
  • NPI 1700538121
  NPD tax ID

Locations

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

{
    "created_epoch": "1743984000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1788134400000",
    "number": "1881488773",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "86 VILLA RD STE 100",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296153052",
            "telephone_number": "864-640-8355"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1472 N GREEN MOUNT RD",
            "city": "O FALLON",
            "state": "IL",
            "postal_code": "622693416",
            "telephone_number": "730-240-8040"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROACTIVE MD IL SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-04-07",
        "last_updated": "2026-08-31",
        "certification_date": "2026-08-31",
        "status": "A",
        "authorized_official_last_name": "KEMBLE",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "ALLEN",
        "authorized_official_title_or_position": "CHIEF MEDICAL OFFICER",
        "authorized_official_telephone_number": "864-640-8355",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "OE 520 Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Bigtyme Price
• Colby James Price, RBT
• Milena Price
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• Kevin L Pritchett, M.D.
• Progressive Spine & Joint Center LLC
• Felicity Nadine Pruitt, RBT
• Cameron Pryor, RBT
• Kostantinos Elias Psihramis, M.D.
• Jessica Jade Pucci, DMD

• Primary Care Clinic/Center in O'Fallon, IL
• Providers in O'Fallon, IL by specialty
• Primary Care Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2026; 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.