CENTRAL ILLINOIS CENTER FOR WELLNESS, LLC (NPI# 1104391739) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1104391739 |
| Entity Type | Organization |
| Organization Name | CENTRAL ILLINOIS CENTER FOR WELLNESS, LLC |
| Practice Address |
2005 Jacobssen Dr Ste A Normal IL 61761-6288 |
| Practice Telephone | 3098075356 |
| Practice Fax Number | 3098075291 |
| Mailing Telephone | 3098075356 |
| Mailing Fax Number | 3098075291 |
| Enumeration Date | 2018-10-10 |
| Last Update Date | 2018-10-10 |
| Authorized Official Name | WILLIAM JOHN RAY (PHYSICIAN/OWNER) |
| Authorized Official Telephone | 3098075356 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QP2300X |
Clinic/Center Specialization: Primary Care |
Ambulatory Health Care Facilities |
| Street Address |
2005 JACOBSSEN DR STE A |
| City | NORMAL |
| State | IL |
| Zip Code | 61761-6288 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033559802 | Shannon L Laesch | Clinical Nurse Specialist | 2005 Jacobssen Dr Ste A, Normal, IL 61761-6288 | 2013-06-26 |
| 1770027930 | Pro Podiatry, LLC | Podiatrist | 2005 Jacobssen Dr Ste A, Normal, IL 61761-6288 | 2016-12-07 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629681796 | Brittany Nicole Mekley | Nurse Practitioner | 201 N. University, Normal, IL 61761 | 2020-08-28 |
| 1679108971 | Krystal Halliday | Occupational Therapist | 1815 N Towanda Barnes Rd, Normal, IL 61761 | 2020-03-06 |
| 1265915474 | Laine E Burek | Nurse Practitioner | 1765 Bradford Ln., Normal, IL 61761 | 2018-09-13 |
| 1801389986 | Ashley Michelle James | Specialist/Technologist | 347 S. University St, Normal, IL 61761 | 2018-06-12 |
| 1447750708 | Shelley R. Ruch | Specialist/Technologist, Other | 1604 Visa Drive, Ste 1, Normal, IL 61761 | 2018-02-13 |
| 1497275069 | Mclean County Nursing Home | Non-emergency Medical Transport (VAN) | 901 N. Main St, Normal, IL 61761 | 2017-06-23 |
| 1235673666 | Megan Threm | Registered Nurse | 900 Franklin Ave Community Health Care Clinic, Normal, IL 61761 | 2016-12-04 |
| 1437513553 | Tiesha Smith | Specialist | 1800 Rockingham Dr, Apt 1d, Normal, IL 61761 | 2016-04-06 |
| 1285031658 | New Day Recovery | Community/Behavioral Health | 402 Summit, Normal, IL 61761 | 2014-12-01 |
| 1174927701 | Alyssa Marie Bruck | Occupational Therapist | 700 N Walnut St, Normal, IL 61761 | 2014-10-10 |
| Find all providers in zip 61761 | ||||
| Taxonomy Code | 261QP2300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Primary Care |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306040878 | Ambulatory Medical Associates LLC | Clinic/Center | 2010 Jacobssen Dr, Normal, IL 61761-6280 | 2007-06-11 |
| 1457439317 | Nicholas Nayak | Clinic/Center | 2010 Jacobssen Dr, Normal, IL 61761-6280 | 2006-11-01 |
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|---|---|---|---|---|
| 1033724901 | Ar Healthcare | Clinic/Center | 11 E Main St Ste A, St Charles, IL 60174-1925 | 2020-09-08 |
| 1568073674 | Downers Grove Immediate Care Inc. | Clinic/Center | 425 Ogden Ave, Downers Grove, IL 60515-3066 | 2020-08-12 |
| 1538792221 | Greenbax Health Solutions, LLC | Clinic/Center | 4922 W Chicago Ave, Chicago, IL 60651-3142 | 2020-02-20 |
| 1548808728 | Unitypoint Health At Work | Clinic/Center | 1100 13th Ave, East Moline, IL 61244-1455 | 2019-12-18 |
| 1265076749 | Inhome Primecare LLC | Clinic/Center | 6738 N Lockwood Ave, Lincolnwood, IL 60712-3107 | 2019-10-29 |
| 1033760780 | Careatc | Clinic/Center | 600 S Michigan Ave # 402, Chicago, IL 60605-1900 | 2019-09-24 |
| 1356814503 | Thompson Medical Incorporated | Clinic/Center | 933 E Hyde Park Blvd Ste G, Chicago, IL 60615-2722 | 2019-01-09 |
| 1598248106 | Granite City Clinic Corp | Clinic/Center | 602 Farrish St, Madison, IL 62060-1567 | 2018-09-10 |
| 1497251037 | Thomas L Pitts, Md LLC | Clinic/Center | 233 E Erie St Ste 702, Chicago, IL 60611-5933 | 2018-04-03 |
| 1013438704 | Emily Byars | Clinic/Center | 1111 Greenfield Circle, Geneva, IL 60134 | 2017-07-03 |
| 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.