NPIMap

Organization Active NPI

Gibson Community Hospital Association

Doing business as Mahomet Specialty Clinic

  • Orthopaedic Surgery Physician
  • Mahomet, IL
National Provider Identifier
1972926236
Registry record updated Jan 22, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
License
0000836 Issued in IL
Legal business name
GIBSON COMMUNITY HOSPITAL ASSOCIATION
Doing business as
Mahomet Specialty Clinic
Practice address
1504 Patton Dr
Unit #3
Mahomet, IL 61853-8126
Phone
(217) 586-2633
NPI assigned
Jan 22, 2014
Last updated
Jan 22, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 22, 2014

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

Authorized official

Name
Robert C Schmitt II
Title
Ceo
Phone
(217) 784-2600

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery Physician 207X00000X 0000836 IL Primary
Plastic and Reconstructive Surgery Physician 2086S0122X 0000836 IL

Addresses

Primary practice location

1504 Patton Dr
Unit #3
Mahomet, IL 61853-8126

Mailing address

1504 Patton Dr
Unit #3
Mahomet, IL 61853-8126
Phone (217) 586-2633

Other names 1

  • Mahomet Specialty Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040505001293 IL Part B Supplier - Clinic/Group Practice 5092703124 Receives reassigned benefits from 201 practitioners
38 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Watseka, IL; Urbana, IL; Paxton, IL; Fairbury, IL; Onarga, IL; Mahomet, IL; Hoopeston, IL; Gibson City, IL…

Other NPIs on the same Medicare enrollment 38

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 38

National Provider Directory

National Provider Directory

Locations

4 Doctors Park
Gibson City, IL 60936
Phone (217) 784-4540

1504 Patton Dr
Ste 3
Mahomet, IL 61853
Phone (217) 586-2633

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1390348800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1390348800000",
    "number": "1972926236",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1504 PATTON DR",
            "address_2": "UNIT #3",
            "city": "MAHOMET",
            "state": "IL",
            "postal_code": "618538126",
            "telephone_number": "217-586-2633"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1504 PATTON DR",
            "address_2": "UNIT #3",
            "city": "MAHOMET",
            "state": "IL",
            "postal_code": "618538126",
            "telephone_number": "217-586-2633"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GIBSON COMMUNITY HOSPITAL ASSOCIATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-01-22",
        "last_updated": "2014-01-22",
        "status": "A",
        "authorized_official_last_name": "SCHMITT",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "217-784-2600",
        "authorized_official_name_suffix": "II"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "IL",
            "license": "0000836",
            "primary": true
        },
        {
            "code": "2086S0122X",
            "taxonomy_group": "",
            "desc": "Surgery, Plastic and Reconstructive Surgery",
            "state": "IL",
            "license": "0000836",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mahomet Specialty Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mahomet, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2014; 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.