Cep America - Illinois SNF, LLP
Organization Active NPI Internal Medicine Physician · Godfrey, IL
NPI 1891322467 · NPPES record last updated Mar 24, 2020
Key facts
- NPI
- 1891322467
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Internal Medicine Physician 207R00000X
- Legal business name
- CEP AMERICA - ILLINOIS SNF, LLP
- Practice address
- 1623 W Delmar Ave
Godfrey, IL 62035-1317 - Phone
- (618) 498-7157
- NPI assigned
- Mar 24, 2020
- Organization subpart
- No
Authorized official
- Name
- David Birdsall
- Title
- Administrative VP of Operations
- Phone
- (618) 498-7157
Other NPIs on the same Medicare enrollment 17
Corporate family (same tax ID) 9
Practitioners 2
-
Jemila Maxine Crawford, M.D.
-
Pankaj K Kaul, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20161012002933 | IL | Part B Supplier - Clinic/Group Practice | 8022306737 |
Receives reassigned benefits from 53 practitioners 17 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Cahokia, IL; Shiloh, IL; Godfrey, IL; Edwardsville, IL; Caseyville, IL; Breese, IL; Belleville, IL; Alton, IL |
National Provider Directory
- Tax ID family
- Cep America - Illinois SNF LLP
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician |
207R00000X | Yes |
Addresses
Primary practice location
1623 W Delmar Ave
Godfrey, IL 62035-1317
Mailing address
1601 Cummins Dr Ste D
Modesto, CA 95358-6411
Phone (510) 350-2638
Other providers in Godfrey, IL
- Beverly Farm Foundation
- Beverly Farm Living Options
- Derrick Boyd
- Bria of Godfrey LP
- Joshua Seth Brunaugh
- Kristin Anne Childers
- Clarkson Optometry Illinois, P.C.
- Community College District 536
- Kristine M Costello
- Larry Wayne Crocker
All providers in Godfrey, IL · Internal Medicine Physician in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 24, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.