Passavant Physician Association

Primary specialty

Rural Health Clinic/CenterTaxonomy code 261QR1300X

Legal business name

PASSAVANT PHYSICIAN ASSOCIATION

Practice address

559 N Westgate Ave
Jacksonville, IL 62650-1156

Phone

(217) 243-5474

Fax

(217) 245-2322

NPI assigned

Oct 18, 2016

Organization subpart

Yes

Parent organization

PASSAVANT MEMORIAL AREA HOSPITALAs reported in NPPES

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

Authorized official

Name

Mr. Robert Ellison

Title

Director

Phone

(217) 479-5890

Specialties & licenses 4

Addresses

Part of

Passavant Mem Area Hosp

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Passavant Memorial Area Hospital Association

  dba Jacksonville Professional Fees

  • Multi-Specialty Clinic/Center
  • Jacksonville, IL
  • NPI 1235864810

  Member Of

  NPD member

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

{
    "created_epoch": "1476748800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1491264000000",
    "number": "1972054609",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "559 N WESTGATE AVE",
            "city": "JACKSONVILLE",
            "state": "IL",
            "postal_code": "626501156",
            "telephone_number": "217-243-5474",
            "fax_number": "217-245-2322"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "559 N WESTGATE AVE",
            "city": "JACKSONVILLE",
            "state": "IL",
            "postal_code": "626501156",
            "telephone_number": "217-243-5474",
            "fax_number": "217-245-2322"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PASSAVANT PHYSICIAN ASSOCIATION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PASSAVANT MEMORIAL AREA HOSPITAL",
        "enumeration_date": "2016-10-18",
        "last_updated": "2017-04-04",
        "status": "A",
        "authorized_official_last_name": "ELLISON",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "217-479-5890",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Y00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Otolaryngology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Passavant Physician Association
• Passavant Physician Association (Passavant Internal Medicine Rural Health Clinic)
• Passavant Physician Association (Wound Clinic RHC)
• Passavant Physician Association
• Passavant Physician Association
• David Dylan Pate, PA-C
• Mosam B Patel, M.D.
• Pathway Services Unlimited Inc
• Aubrie Laine Patkus, PHARMD
• Peter a Trace, M.D.

• Rural Health Clinic/Center in Jacksonville, IL
• Providers in Jacksonville, IL by specialty
• Rural Health Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2017; 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.