NPIMap

Organization Active NPI

Collaborative Medical PLLC

  • Medical Specialty Clinic/Center
  • Jacksonville, IL
National Provider Identifier
1891494738
Registry record updated Aug 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Specialty Clinic/CenterTaxonomy code 261QM2500X
Legal business name
COLLABORATIVE MEDICAL PLLC
Practice address
1515 W Walnut St Ste 6
Jacksonville, IL 62650-1157
Phone
(217) 243-5313
Fax
(217) 243-7608
NPI assigned
Feb 28, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 23, 2024

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

Authorized official

Name
Dr. James M Casey, DCNPI 1134598386
Title
Owner
Phone
(217) 473-8265

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Specialty Clinic/Center 261QM2500X Primary
Pain Clinic/Center 261QP3300X
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X

Addresses

Primary practice location

1515 W Walnut St Ste 6
Jacksonville, IL 62650-1157

Mailing address

1515 W Walnut St Ste 6
Jacksonville, IL 62650-1157
Phone (217) 243-5313

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230816000091 IL Part B Supplier - Clinic/Group Practice 5092177592 Receives reassigned benefits from 3 practitioners
Practice locations: Jacksonville, IL

National Provider Directory

National Provider Directory

Locations

1515 W Walnut St
Ste 6
Jacksonville, IL 62650
Phone (217) 243-5313

Practitioners & affiliated clinicians

Practitioners 5

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

NPI Registry JSON

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

{
    "created_epoch": "1677542400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724371200000",
    "number": "1891494738",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1515 W WALNUT ST STE 6",
            "city": "JACKSONVILLE",
            "state": "IL",
            "postal_code": "626501157",
            "telephone_number": "217-243-5313",
            "fax_number": "217-243-7608"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1515 W WALNUT ST STE 6",
            "city": "JACKSONVILLE",
            "state": "IL",
            "postal_code": "626501157",
            "telephone_number": "217-243-5313",
            "fax_number": "217-243-7608"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLLABORATIVE MEDICAL PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-02-28",
        "last_updated": "2024-08-23",
        "certification_date": "2024-08-23",
        "status": "A",
        "authorized_official_last_name": "CASEY",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "217-473-8265",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QP3300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Pain",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.