DR. SHANE C. FOGO (NPI# 1063446318) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1063446318 |
| Entity Type | Individual |
| Full Name | DR. SHANE C. FOGO |
| Credential | M.D. |
| Practice Address |
105 S Major St Eureka IL 61530-1246 |
| Mailing Address |
701 Lee St Suite 300 Des Plaines IL 60016-4539 |
| Practice Telephone | 3094674691 |
| Mailing Telephone | 8473905900 |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2012-12-14 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | 036111674 | IL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | 036111674 | 05 | |
| IL | BCBS HPT | 5715395 | 01 |
| IL | BCBS TCH | 10215111 | 01 |
| Street Address |
105 S MAJOR ST |
| City | EUREKA |
| State | IL |
| Zip Code | 61530-1246 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841230752 | Jennifer S. Hoffman | Nurse Practitioner | 105 S Major St, Eureka, IL 61530-1246 | 2006-06-08 |
| 1780101204 | Carle Eureka Hospital | Clinic/Center | 105 S Major St, Eureka, IL 61530-1246 | 2017-08-25 |
| 1831610898 | Alexa Miller | Family Medicine | 105 S Major St, Eureka, IL 61530-1246 | 2017-06-29 |
| 1861913899 | Hilary Norton | Family Medicine | 105 S Major St, Eureka, IL 61530-1246 | 2017-06-29 |
| 1962941419 | Alexandra Cessna Farmer | Physician Assistant | 105 S Major St, Eureka, IL 61530-1246 | 2017-02-16 |
| 1013385079 | Morgan Elizabeth Harris | Nurse Practitioner | 105 S Major St, Eureka, IL 61530-1246 | 2015-09-08 |
| 1629155460 | Bromenn Physicians Management Corporation | Family Medicine | 105 S Major St, Eureka, IL 61530-1246 | 2006-11-01 |
| 1437178415 | David L. Miller | Family Medicine | 105 S Major St, Eureka, IL 61530-1246 | 2006-07-19 |
| 1295754984 | Amy Zacharias | Family Medicine | 105 S Major St, Eureka, IL 61530-1246 | 2006-07-19 |
| 1558380246 | Tina M. Schaffer | Nurse Practitioner | 105 S Major St, Eureka, IL 61530-1246 | 2006-07-19 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134464316 | Tazwood Mental Health Center, Inc. | Community/Behavioral Health | 101 S. Major Street, Eureka, IL 61530 | 2012-11-29 |
| 1508009234 | Woodford County | Substance Abuse Rehabilitation Facility | 105 E Court St, Eureka, IL 61530 | 2009-04-10 |
| 1609889914 | Apostolic Christian Home of Eureka | Skilled Nursing Facility | 610 W. Cruger St., Eureka, IL 61530 | 2006-08-15 |
| 1326003344 | Eric John Larson | Counselor | 109 E Eureka, Eureka, IL 61530 | 2006-04-20 |
| 1467789511 | Julie Tuttle | Clinical Nurse Specialist | 530 Ne Glen Oak Ave, Peoria, IL 61530 | 2009-11-11 |
| 1720073414 | Maple Lawn Health Center | Skilled Nursing Facility | 700 N Main St, Eureka, IL 61530-1085 | 2005-09-19 |
| 1992158356 | Kendra Mickelson | Skilled Nursing Facility | 700 N Main St, Eureka, IL 61530-1085 | 2016-07-20 |
| 1720439110 | Loft Rehabilitation and Nursing LLC | Skilled Nursing Facility | 700 N Main St, Eureka, IL 61530-1085 | 2016-06-27 |
| 1841470374 | Maple Lawn Homes Inc. | Clinic/Center | 700 N Main St, Eureka, IL 61530-1085 | 2007-11-13 |
| 1093818767 | Highland Park Cvs, L.L.C. | Durable Medical Equipment & Medical Supplies | 501 W Center St, Eureka, IL 61530-1111 | 2006-09-07 |
| Find all providers in zip 61530 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497257281 | Primary Care of Cedar Hill LLC | Family Medicine | 103 Hilltop Village Center Dr, Eureka, MO 63025-1108 | 2018-03-07 |
| 1124407341 | Basham Clinic, P.a. | Family Medicine | 100 E 16th St, Eureka, KS 67045-1067 | 2015-05-20 |
| 1669780433 | Jason Wayne Defluiter | Family Medicine | 1343 Highway 93 North, Eureka, MT 59917-9503 | 2010-09-15 |
| 1548388077 | Heather D Gjorgjievski | Family Medicine | 103 Hilltop Village Shopping Center Dr., Eureka, MO 63025 | 2007-03-26 |
| 1285780916 | Douglas Wilson Wimer | Family Medicine | 2504 Harrison Ave Ste A, Eureka, CA 95501-3221 | 2007-01-26 |
| 1083775373 | Scott Louis Sattler | Family Medicine | 2466 Russell St, Eureka, CA 95503-5648 | 2006-12-12 |
| 1477647287 | Laurence Eugene Badgley | Family Medicine | 2504 Harrison Avenue, Suite B, Eureka, CA 95501 | 2006-10-03 |
| 1629173398 | David Lawrence Pittenger | Family Medicine | 97 Hill Top Village Center, Suite E & F, Eureka, MO 63025-1184 | 2006-09-14 |
| 1881601615 | Gregory S Holst | Family Medicine | 2675 Harris Street, Eureka, CA 95503 | 2006-08-02 |
| 1477589323 | Willard Merrell Hunter | Family Medicine | 2412 Buhne St, Eureka, CA 95501-3207 | 2006-06-23 |
| Find all providers in EUREKA | ||||
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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.