NPIMap

Organization Active NPI

Physical Medicine Clinic of Granite City LTD

  • Adult Health Nurse Practitioner
  • Granite City, IL
National Provider Identifier
1992039747
Registry record updated Oct 15, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
209007631 Issued in IL
Legal business name
PHYSICAL MEDICINE CLINIC OF GRANITE CITY LTD
Practice address
2861 Madison Ave
Granite City, IL 62040-3614
Phone
(618) 877-4000
Fax
(618) 877-0874
NPI assigned
Sep 28, 2009
Last updated
Oct 15, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 15, 2013

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

Authorized official

Name
Dr. Bridget Brasfield, D.C.NPI 1205948577
Title
Owner/Chiropractor
Phone
(618) 877-4000

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193200000X MULTI-SPECIALTY GROUP 111N00000X 038009646 IL
Adult Health Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LA2200X 209007631 IL Primary

Addresses

Primary practice location

2861 Madison Ave
Granite City, IL 62040-3614

Mailing address

2861 Madison Ave
Granite City, IL 62040-3614
Phone (618) 877-4000

National Provider Directory

National Provider Directory

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 1

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": "1254096000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1381795200000",
    "number": "1992039747",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2861 MADISON AVE",
            "city": "GRANITE CITY",
            "state": "IL",
            "postal_code": "620403614",
            "telephone_number": "618-877-4000",
            "fax_number": "618-877-0874"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2861 MADISON AVE",
            "city": "GRANITE CITY",
            "state": "IL",
            "postal_code": "620403614",
            "telephone_number": "618-877-4000",
            "fax_number": "618-877-0874"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHYSICAL MEDICINE CLINIC OF GRANITE CITY LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-09-28",
        "last_updated": "2013-10-15",
        "status": "A",
        "authorized_official_last_name": "BRASFIELD",
        "authorized_official_first_name": "BRIDGET",
        "authorized_official_title_or_position": "OWNER/CHIROPRACTOR",
        "authorized_official_telephone_number": "618-877-4000",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "IL",
            "license": "038009646",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "IL",
            "license": "209007631",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Granite City, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2013; 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.