NORTH DIRKSEN MEDICAL ASSOCIATES, LLC (NPI# 1063646040) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1063646040 |
| Entity Type | Organization |
| Organization Name | NORTH DIRKSEN MEDICAL ASSOCIATES, LLC |
| Practice Address |
3220 Atlanta St Springfield IL 62707-8801 |
| Mailing Address |
Po Box 3428 Springfield IL 62708-3428 |
| Practice Telephone | 2175887400 |
| Mailing Telephone | 8005775368 |
| Mailing Fax Number | 2177572021 |
| Enumeration Date | 2009-05-06 |
| Last Update Date | 2009-05-06 |
| Authorized Official Name | J. TRAVIS DOWELL (VICE PRESIDENT HCNA AND OPERATIONS) |
| Authorized Official Telephone | 2177883342 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363L00000X | Nurse Practitioner | Physician Assistants & Advanced Practice Nursing Providers | ||
| Y | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians |
| Street Address |
3220 ATLANTA ST |
| City | SPRINGFIELD |
| State | IL |
| Zip Code | 62707-8801 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972716033 | Joshua Ellison | Family Medicine | 3220 Atlanta St, Springfield, IL 62707-8801 | 2007-05-07 |
| 1376195818 | Kelsi Earl | Registered Nurse | 3220 Atlanta St, Springfield, IL 62707-8801 | 2019-07-15 |
| 1447737499 | Alison M Peddycoart | Nurse Practitioner | 3220 Atlanta St, Springfield, IL 62707-8801 | 2018-07-23 |
| 1336642867 | Christina Rovey | Nurse Practitioner | 3220 Atlanta St, Springfield, IL 62707-8801 | 2018-03-12 |
| 1356850713 | Katie M Turley | Social Worker | 3220 Atlanta St, Springfield, IL 62707-8801 | 2017-09-28 |
| 1639603293 | Tatonya Roberts | Nurse Practitioner | 3220 Atlanta St, Springfield, IL 62707-8801 | 2017-04-20 |
| 1790219459 | Latoya Bond | Nurse Practitioner | 3220 Atlanta St, Springfield, IL 62707-8801 | 2017-04-19 |
| 1588198246 | Chaney Marie Bell | Nurse Practitioner | 3220 Atlanta St, Springfield, IL 62707-8801 | 2017-04-19 |
| 1992169668 | Walgreen Co | Pharmacy | 3220 Atlanta St, Springfield, IL 62707-8801 | 2016-04-08 |
| 1003276189 | Lindsey Ostermeier | Nurse Practitioner | 3220 Atlanta St, Springfield, IL 62707-8801 | 2016-03-02 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730405051 | Bret Lee Miller | Pharmacist | 3250 Clear Lake Ave, Springfield, IL 62707 | 2010-04-12 |
| 1740402890 | Bennie Joe Manley | Counselor | 3200 Shaler Road, Springfield, IL 62707 | 2007-05-02 |
| 1568493336 | Andrea N. Johnson | Counselor | 3270 Moore Rd, Springfield, IL 62707-2515 | 2006-07-06 |
| 1376184820 | Kevin Polk | Marriage & Family Therapist | 350 Bourbon St, Springfield, IL 62707-2702 | 2019-10-07 |
| 1205050192 | Amaretta Marie Gilmer | Speech-Language Pathologist | 4046 Mcconnell Ct, Springfield, IL 62707-3018 | 2007-04-12 |
| 1376766204 | Marcia H. Bunchman | Speech-Language Pathologist | 34 Cabin Smoke Trl, Springfield, IL 62707-4509 | 2007-04-10 |
| 1205027026 | Christie M Davis | Physical Therapist | 51 Frontier Lake Dr, Springfield, IL 62707-7726 | 2007-08-06 |
| 1912975160 | Harold Jay Bruninga | Ophthalmology | 900 Capital Airport Dr, Springfield, IL 62707-8410 | 2006-03-12 |
| 1982044889 | Stouffer Clinical Counseling & Consulting LLC | Community/Behavioral Health | 900 Capital Airport Dr, Springfield, IL 62707-8410 | 2013-06-25 |
| 1407296395 | Kevin R Stouffer | Counselor | 900 Capital Airport Dr, Springfield, IL 62707-8410 | 2013-06-25 |
| Find all providers in zip 62707 | ||||
| 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 |
|---|---|---|---|---|
| 1841802592 | Community Health and Wellness Services, Inc. | Family Medicine | 312 Memorial Park Dr, Springfield, PA 19064-1714 | 2020-08-22 |
| 1649815796 | 180 Health Lifestyle Wellness Centers | Family Medicine | 1936 S Glenstone Ave, Springfield, MO 65804-2305 | 2019-11-13 |
| 1790337988 | Aminat Ogun | Family Medicine | 520 N 4th St # 62702, Springfield, IL 62702-5238 | 2019-07-09 |
| 1770076622 | Thomas John Schumann | Family Medicine | 1260 E. Woodlawn Ave, Suite 200, Springfield, PA 19064-3988 | 2018-06-14 |
| 1134648959 | Patricia Derges | Family Medicine | 3259 E Sunshine St Ste Aa, Springfield, MO 65804-2114 | 2017-09-12 |
| 1740704667 | Mercy Management of Sepa | Family Medicine | 1001 Baltimore Pike Ste 109, Springfield, PA 19064-2852 | 2017-08-02 |
| 1083134902 | Trevor Conner | Family Medicine | 1423 N Jefferson Ave, B100, Springfield, MO 65802 | 2017-06-21 |
| 1790215853 | Vincent Marchese | Family Medicine | 1260 E Woodland Ave Ste 200, Springfield, PA 19064-3956 | 2017-06-12 |
| 1184152100 | Canaan Arceneaux | Family Medicine | 1001 Baltimore Pike Ste 106, Springfield, PA 19064-2800 | 2017-06-03 |
| 1063943587 | Cody Stark Rogers | Family Medicine | 1423 N Jefferson Ave # A100, Springfield, MO 65802-1988 | 2017-03-26 |
| Find all providers in SPRINGFIELD | ||||
| City | SPRINGFIELD |
| Zip Code | 62707 |
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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.