NPIMap

Organization Active NPI

Pana Community Hospital Association

Doing business as Community Medical Clinic of Nokomis

  • Family Medicine Physician
  • Nokomis, IL
National Provider Identifier
1992994461
Registry record updated Jan 31, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
PANA COMMUNITY HOSPITAL ASSOCIATION
Doing business as
Community Medical Clinic of Nokomis
Practice address
120 S Cedar St
Nokomis, IL 62075-1647
Phone
(217) 562-2544
Fax
(217) 562-6288
NPI assigned
Oct 19, 2007
Last updated
Jan 31, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 31, 2008

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

Authorized official

Name
Lisa Marie Bloemer
Title
Office Manager
Phone
(217) 562-2544

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

120 S Cedar St
Nokomis, IL 62075-1647

Mailing address

120 S Cedar St
Nokomis, IL 62075-1647
Phone (217) 562-2544

Other names 1

  • COMMUNITY MEDICAL CLINIC OF NOKOMIS Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031121000350 IL Part B Supplier - Clinic/Group Practice 3274437348 Receives reassigned benefits from 97 practitioners
6 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Moweaqua, IL; Ramsey, IL; Pana, IL; Nokomis, IL

Other NPIs on the same Medicare enrollment 6

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

National Provider Directory

National Provider Directory
Tax ID family
Invalid Entry17 organizations share this tax ID, including this one

Other organizations with this tax ID 16

Organizations that report the same tax identification number in the National Provider Directory.

View all 16

Practitioners & affiliated clinicians

Practitioners 20

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.

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1192752000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1201737600000",
    "number": "1992994461",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "120 S CEDAR ST",
            "city": "NOKOMIS",
            "state": "IL",
            "postal_code": "620751647",
            "telephone_number": "217-562-2544",
            "fax_number": "217-562-6288"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 S CEDAR ST",
            "city": "NOKOMIS",
            "state": "IL",
            "postal_code": "620751647",
            "telephone_number": "217-562-2544",
            "fax_number": "217-562-6288"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PANA COMMUNITY HOSPITAL ASSOCIATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-19",
        "last_updated": "2008-01-31",
        "status": "A",
        "authorized_official_last_name": "BLOEMER",
        "authorized_official_first_name": "LISA",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "217-562-2544"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "COMMUNITY MEDICAL CLINIC OF NOKOMIS",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Nokomis, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2008; 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.