Medical Group of Kankakee County
Organization Active NPI Family Medicine Physician · Herscher, IL
NPI 1962588095 · NPPES record last updated Mar 30, 2015
Key facts
- NPI
- 1962588095
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- MEDICAL GROUP OF KANKAKEE COUNTY
- Practice address
- 692 N. Maple
Herscher, IL 60941 - Phone
- (815) 426-2020
- NPI assigned
- Oct 31, 2006
- Organization subpart
- No
Authorized official
- Name
- Jeffery Long, MD
- Title
- Director
- Phone
- (815) 426-2020
Practitioners 10
-
Megan Brown, NP-C
-
Jeffery Long, MD
-
Hashim Raza Zaidi, M.D.
-
Kristy Patterson, PA
-
Melissa Ann Van Hoof, PA-C
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 14D0994534 | Med Group of Kankakee County LLC,the | Certificate of waiver | Dec 23, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031231000561 | IL | Part B Supplier - Clinic/Group Practice | 3577462258 |
Receives reassigned benefits from 7 practitioners Practice locations: Bradley, IL; Herscher, IL |
National Provider Directory
Locations
555 E North St
Bradley, IL 60915
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | Yes |
Addresses
Primary practice location
692 N. Maple
Herscher, IL 60941
Mailing address
692 N Maple St
Herscher, IL 60941-9785
Phone (815) 426-2020
Other providers in Herscher, IL
- Arthur R Kremer
- Long Family Development LLC
- Jeffery Long
- Patrick Hale Long
- Dana M Masching
- Kayla Offermann
- Marissa Pasqualetti
- Kristy Patterson
- Pilot Fire Protection District Ambulance Service
- Amy E Wenzelman
All providers in Herscher, IL · Family 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 30, 2015. 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.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.