MERCY CLINIC SURGICAL SPECIALISTS-ILLINOIS LLC (NPI# 1043713886) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1043713886 |
| Entity Type | Organization |
| Organization Name | MERCY CLINIC SURGICAL SPECIALISTS-ILLINOIS LLC |
| Practice Address |
2227 Vadalabene Dr Ste 200 Maryville IL 62062-5824 |
| Practice Telephone | 6182882052 |
| Mailing Telephone | 6182882052 |
| Enumeration Date | 2018-03-16 |
| Last Update Date | 2019-09-12 |
| Authorized Official Name | JEFFREY CIARAMITA (PRESIDENT) |
| Authorized Official Telephone | 3145251785 |
| Authorized Official Credential | MD |
| Is Organization Subpart | Y |
| Parent Organization Name | MERCY CLINIC EAST COMMUNITIES |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208600000X | Surgery | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MO | 500052754 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 6812 State Route 162 Ste 121, Maryville, IL 620628586 | 3145435999 |
| Street Address |
2227 VADALABENE DR STE 200 |
| City | MARYVILLE |
| State | IL |
| Zip Code | 62062-5824 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578017596 | Mercy Clinic Specialists Services-illinois LLC | Internal Medicine | 2227 Vadalabene Dr Ste 200, Maryville, IL 62062-5824 | 2016-08-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104325091 | Jennifer M Oyler | Physician Assistant | 6812 State Route 162 Suite 120, Maryville, IL 62062 | 2018-02-06 |
| 1710495965 | Sarah Elizabeth Barto | Family Medicine | 2133 Vadalabene Drive, Suite Sb, Maryville, IL 62062 | 2018-01-22 |
| 1104348085 | Lindsey Nicole Langendorf | Chiropractor | 62 Executive Plaza Ct, Maryville, IL 62062 | 2017-07-12 |
| 1043750540 | Gina Saal | Nurse Anesthetist, Certified Registered | 6800 Rt 162, Maryville, IL 62062 | 2017-03-02 |
| 1548657737 | Karen Michelle Bertels | Emergency Medicine | 6800 Il - 162, Maryville, IL 62062 | 2015-04-25 |
| 1811258148 | Debra Ann Hoelscher | Internal Medicine | 2102 Vadalabene, Maryville, IL 62062 | 2012-06-04 |
| 1538438445 | Casey Elizabeth Wiesemeyer | Speech-Language Pathologist | 2201 Copper Creek Rd, Maryville, IL 62062 | 2011-12-21 |
| 1407144819 | Norah Claire Farley Baker | Family Medicine | 10 Professional Park Dr., Maryville, IL 62062 | 2011-07-19 |
| 1891092474 | Kimberly M Schneider | Physician Assistant | 20b Professional Park Drive, Maryville, IL 62062 | 2011-02-17 |
| 1669782397 | Purandhri Patel | Physical Therapist | 6820 State Route 162, Maryville, IL 62062 | 2010-10-15 |
| Find all providers in zip 62062 | ||||
| Taxonomy Code | 208600000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Surgery |
| A general surgeon has expertise related to the diagnosis - preoperative, operative and postoperative management - and management of complications of surgical conditions in the following areas: alimentary tract; abdomen; breast, skin and soft tissue; endocrine system; head and neck surgery; pediatric surgery; surgical critical care; surgical oncology; trauma and burns; and vascular surgery. General surgeons increasingly provide care through the use of minimally invasive and endoscopic techniques. Many general surgeons also possess expertise in transplantation surgery, plastic surgery and cardiothoracic surgery. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Surgery, 2007. http://www.absurgery.org/. American Osteopathic Board of Surgery, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Surgery. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043425481 | Surgical Specialists of Tennessee, Plc | Surgery | 1111 E Lamar Alexander Pkwy, Maryville, TN 37804-5130 | 2007-05-11 |
| 1538283007 | Randal L Croshaw | Surgery | 200 Bmh Cancer Ctr, Maryville, TN 37804-5922 | 2007-03-19 |
| 1053452425 | Melissa Emlyn Trekell | Surgery | 1111 E. Lamar Alexander Parkway, Maryville, TN 37804-5130 | 2007-02-09 |
| 1740364173 | Sps Surgical Services, Sc | Surgery | 6810 State Route 162 Ste 10, Maryville, IL 62062-8501 | 2006-10-24 |
| 1053349084 | Budayr & Associates | Surgery | 405 Bmh Cancer Center, Maryville, TN 37804-5134 | 2006-06-29 |
| 1720055148 | Daniel Steven Johnson | Surgery | 6810 State Route 162 Ste 100, Maryville, IL 62062-8560 | 2006-03-03 |
| 1912908146 | Mahdi M Budayr | Surgery | 405 Bmh Physicians Office Bldg, Maryville, TN 37804-5807 | 2005-08-10 |
| 1356762447 | Serenity Surgery | Surgery | 2227 Vadalabene Dr, Maryville, IL 62062-5823 | 2013-12-17 |
| 1790117596 | Hania B Bednarski Do Sc | Surgery | 2227 Vadalabene Dr, Suite 300, Maryville, IL 62062-5823 | 2013-08-02 |
| 1093026627 | Stephen E Pacifico | Surgery | 250 Bmh Physicians Office Bldg, Maryville, TN 37804-5904 | 2010-06-29 |
| Find all providers in MARYVILLE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.