MEMORIAL MEDICAL GROUP, LLC (NPI# 1235474057) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1235474057 |
| Entity Type | Organization |
| Organization Name | MEMORIAL MEDICAL GROUP, LLC |
| Practice Address |
4550 Memorial Dr Ste. 340 Belleville IL 62226-5372 |
| Practice Telephone | 6182576302 |
| Practice Fax Number | 6182574838 |
| Mailing Telephone | 6182576302 |
| Mailing Fax Number | 6182574838 |
| Enumeration Date | 2012-12-05 |
| Last Update Date | 2012-12-05 |
| Authorized Official Name | MR. JAMES B. DAVIS (EXECUTIVE DIRECTOR) |
| Authorized Official Telephone | 6182576302 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207LP2900X |
Anesthesiology Specialization: Pain Medicine |
Allopathic & Osteopathic Physicians | ||
| N | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians | ||
| N | 207RC0000X |
Internal Medicine Specialization: Cardiovascular Disease |
Allopathic & Osteopathic Physicians | ||
| N | 207RC0001X |
Internal Medicine Specialization: Clinical Cardiac Electrophysiology |
Allopathic & Osteopathic Physicians | ||
| N | 207RG0100X |
Internal Medicine Specialization: Gastroenterology |
Allopathic & Osteopathic Physicians | ||
| N | 207RG0300X |
Internal Medicine Specialization: Geriatric Medicine |
Allopathic & Osteopathic Physicians | ||
| N | 207RP1001X |
Internal Medicine Specialization: Pulmonary Disease |
Allopathic & Osteopathic Physicians | ||
| N | 207RS0010X |
Internal Medicine Specialization: Sports Medicine |
Allopathic & Osteopathic Physicians | ||
| N | 207V00000X | Obstetrics & Gynecology | Allopathic & Osteopathic Physicians | ||
| N | 207X00000X | Orthopaedic Surgery | Allopathic & Osteopathic Physicians | ||
| N | 208100000X | Physical Medicine & Rehabilitation | Allopathic & Osteopathic Physicians | ||
| N | 2086S0122X |
Surgery Specialization: Plastic and Reconstructive Surgery |
Allopathic & Osteopathic Physicians | ||
| N | 2086S0129X |
Surgery Specialization: Vascular Surgery |
Allopathic & Osteopathic Physicians | ||
| N | 208800000X | Urology | Allopathic & Osteopathic Physicians | ||
| Y | 207R00000X | Internal Medicine | Allopathic & Osteopathic Physicians |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750846663 | Memorial Medical Group, LLC | Family Medicine | 1701 Oak Park Blvd, Lake Charles, LA 70601-8911 | 2019-02-05 |
| Street Address |
4550 MEMORIAL DR STE. 340 |
| City | BELLEVILLE |
| State | IL |
| Zip Code | 62226-5372 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427055961 | Lawrence Mcclinton | Physician Assistant | 4550 Memorial Dr, Ste. 280, Belleville, IL 62226-5372 | 2005-06-30 |
| 1902273717 | Tammi Lynn Jones | Nurse Practitioner | 4550 Memorial Dr, Suite 360, Belleville, IL 62226-5372 | 2015-08-27 |
| 1013265248 | Deanna L. Rodenberg | Registered Nurse | 4550 Memorial Dr, Ste. 340, Belleville, IL 62226-5372 | 2012-08-20 |
| 1699061259 | Oa Associated LLC | Specialist/Technologist | 4550 Memorial Dr, Moc-1, Suite G-100, Belleville, IL 62226-5372 | 2011-06-22 |
| 1619260932 | Dori Hunt | Nurse Practitioner | 4550 Memorial Dr, Ste. 340, Belleville, IL 62226-5372 | 2011-05-19 |
| 1821302118 | Pc Associates, LLC | Hospitalist | 4550 Memorial Dr, Suite 340, Belleville, IL 62226-5372 | 2010-07-29 |
| 1386958668 | Pc Associates, LLC | Family Medicine | 4550 Memorial Dr, Ste 180, Belleville, IL 62226-5372 | 2010-07-29 |
| 1376857656 | Ca Group, LLC | Internal Medicine | 4550 Memorial Dr, Ste 310, Belleville, IL 62226-5372 | 2010-07-29 |
| 1649584921 | Ca Group LLC | Internal Medicine | 4550 Memorial Dr, Suite 320, Belleville, IL 62226-5372 | 2010-07-29 |
| 1295049666 | Msa Alliance, LLC | Urology | 4550 Memorial Dr, Ste 350, Belleville, IL 62226-5372 | 2010-07-28 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639778160 | Roxanna Lee Gunnels | Nurse Practitioner | 1 Bronze Pointe Plaza Suite 1a, Swansea, IL 62226 | 2020-10-26 |
| 1053969790 | Consistent Medical Transportation | Driver | 2012 N 17th St, Swansea, IL 62226 | 2019-08-27 |
| 1497314371 | Medi-plex Hospice of Illinois, LLC | Registered Nurse | 8 Park Place, Suite #3, Swansea, IL 62226 | 2019-06-13 |
| 1336617364 | Nicole Renee Schmidt | Speech-Language Pathologist | 150 N 27th St., Belleville, IL 62226 | 2018-11-07 |
| 1295258903 | Catherine Espino | Pharmacist | 11 Chambers Blvd, Swansea, IL 62226 | 2017-07-25 |
| 1366806838 | Kiley Faires | Nurse Practitioner | 4600 Memorial Drive Ste 360, Belleville, IL 62226 | 2016-04-11 |
| 1760857585 | Mvp Transportation | Non-emergency Medical Transport (VAN) | 1229 N 17th Street, Number 23, Belleville, IL 62226 | 2015-12-04 |
| 1275952566 | Aisha Danyale Franklin | Internal Medicine | 4261 Woodfield Pl, Belleville, IL 62226 | 2014-04-15 |
| 1396168332 | Jayne E. Ninness | Physical Therapy Assistant | 4500 Memorial Dr., Memorial Hospital, Belleville, IL 62226 | 2014-01-28 |
| 1053758193 | Gateway Foundation, Inc. | Clinic/Center | 1 Bronze Point, Suite 1, Swansea, IL 62226 | 2013-05-30 |
| Find all providers in zip 62226 | ||||
| Taxonomy Code | 207R00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952953903 | Dr. Nesochi LLC | Internal Medicine | 50 Newark Ave Ste 108, Belleville, NJ 07109-1193 | 2019-07-10 |
| 1275952566 | Aisha Danyale Franklin | Internal Medicine | 4261 Woodfield Pl, Belleville, IL 62226 | 2014-04-15 |
| 1730501206 | Maria Bernadette Bahena Yballe | Internal Medicine | 40 Bernice Rd, Belleville, NJ 07109-1508 | 2014-01-17 |
| 1578861787 | Medical Board Prep Inc | Internal Medicine | 5 Franklin Ave Ste 505, Belleville, NJ 07109-3566 | 2011-03-11 |
| 1558695494 | Paul Anthony Rusnack | Internal Medicine | 6 Sixteenth Green Ct, Belleville, IL 62220-4836 | 2009-09-24 |
| 1376785626 | Mustafa Sidali Do PC | Internal Medicine | 380 Union Ave, Belleville, NJ 07109-2122 | 2009-04-01 |
| 1003096140 | Dennis P Larson | Internal Medicine | 509 E Waters Edge Dr, Belleville, IL 62221-7813 | 2007-11-06 |
| 1336273119 | Jawad Khan | Internal Medicine | 8601 West Main Street, Suite 101, Belleville, IL 62223 | 2007-03-15 |
| 1649321183 | Ventrapragada S Mohan | Internal Medicine | 340 W Lincoln St Ste 300, Belleville, IL 62220-1900 | 2007-01-12 |
| 1710075452 | Francis Thomas Molinari | Internal Medicine | 625 Joralemon Street, Belleville, NJ 07109 | 2006-10-10 |
| Find all providers in BELLEVILLE | ||||
| City | BELLEVILLE |
| Zip Code | 62226 |
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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.