REGENCY MARK MEDICAL GROUP LLC (NPI# 1063034783) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1063034783 |
| Entity Type | Organization |
| Organization Name | REGENCY MARK MEDICAL GROUP LLC |
| Practice Address |
124 Regency Park Ste 7 O Fallon IL 62269-1994 |
| Mailing Address |
2250 E Germann Rd Ste 8 Chandler AZ 85286-1575 |
| Practice Telephone | 4809262260 |
| Enumeration Date | 2020-05-15 |
| Last Update Date | 2020-05-15 |
| Authorized Official Name | MINOO RAHIMI (CFO) |
| Authorized Official Telephone | 4809267800 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363A00000X | Physician Assistant | Physician Assistants & Advanced Practice Nursing Providers | ||
| N | 363LF0000X |
Nurse Practitioner Specialization: Family |
Physician Assistants & Advanced Practice Nursing Providers | ||
| N | 111N00000X | Chiropractor | Chiropractic Providers | ||
| N | 225100000X | Physical Therapist | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | ||
| Y | 208D00000X | General Practice | Allopathic & Osteopathic Physicians |
| Street Address |
124 REGENCY PARK STE 7 |
| City | O FALLON |
| State | IL |
| Zip Code | 62269-1994 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942712310 | Shannon Marie Williams | Nurse Practitioner | 124 Regency Park Ste 7, O Fallon, IL 62269-1994 | 2017-10-25 |
| 1871115592 | Schantz Medical Group LLC | Chiropractor | 124 Regency Park Ste 7, O Fallon, IL 62269-1994 | 2020-05-15 |
| 1043832769 | Main Street Medical Group LLC | Chiropractor | 124 Regency Park Ste 7, O Fallon, IL 62269-1994 | 2020-05-15 |
| 1891317517 | O Fallon Medical Ventures LLC | Chiropractor | 124 Regency Park Ste 7, O Fallon, IL 62269-1994 | 2020-05-15 |
| 1740788587 | New Heights Chiropractic | Chiropractor | 124 Regency Park Ste 7, O Fallon, IL 62269-1994 | 2018-01-26 |
| 1114431616 | New Heights Integrated Health Sc | Clinic/Center | 124 Regency Park Ste 7, O Fallon, IL 62269-1994 | 2017-11-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326648155 | Kayla Revermann | Pharmacist | 1350 W Us Highway 50, Pharmacy, O Fallon, IL 62269 | 2020-10-30 |
| 1942814272 | Ashley Monique Gibson | Behavior Technician | Eagle Center, Ste 10, Ofallon, IL 62269 | 2020-09-03 |
| 1013533819 | Michelle Denise Voudrie | Registered Nurse | 321 Regency Park, O'fallon, IL 62269 | 2020-06-18 |
| 1598398455 | Washington University Physicians In Illinois - Cancer Center Pharmacy | Pharmacy | 1418 Cross Street, Suite 180, Shiloh, IL 62269 | 2020-02-19 |
| 1962063800 | Gerald Paskert | Pharmacist | 122 W. State St., O'fallon, IL 62269 | 2019-06-21 |
| 1780144808 | Bonnie Jean Lampe | Physical Therapy Assistant | 316 Donna Dr, O'fallon, IL 62269 | 2019-03-24 |
| 1134633993 | Latisha Smith | Psychologist | 600 S. Smiley St., O'fallon, IL 62269 | 2017-11-30 |
| 1619407210 | Brenna M Thomas | Registered Nurse | 1310 Engle Ct, O'fallon, IL 62269 | 2017-06-15 |
| 1881135622 | Pc Associates, LLC | Family Medicine | 800 East Highway 50, O'fallon, IL 62269 | 2017-03-13 |
| 1700230539 | Jennifer Farrell | Family Medicine | 3 St. Elizabeth's Blvd, Ste. 4000, O'fallon, IL 62269 | 2016-04-18 |
| Find all providers in zip 62269 | ||||
| Taxonomy Code | 208D00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | General Practice |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861481558 | John Frank Anzalone | General Practice | 1055 E Terra Ln, O Fallon, MO 63366-2750 | 2005-10-17 |
| 1811076052 | Robert F Ladove | General Practice | 916 Talon Dr, Suite 102, O Fallon, IL 62269-1848 | 2006-11-06 |
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| 1306311725 | Genesis Integrative Medicine LLC | General Practice | 1881 S Randall Rd Ste C, Geneva, IL 60134-2532 | 2018-10-11 |
| Find all providers with the same taxonomy | ||||
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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.