CROSSROADS PHYSICIAN CORP (NPI# 1366504888) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1366504888 |
| Entity Type | Organization |
| Organization Name | CROSSROADS PHYSICIAN CORP |
| Other Organization Name | CROSSROADS FAMILY MEDICINE OF MCLEANSBORO |
| Practice Address |
208 S Washington Street Mcleansboro IL 62859 |
| Practice Telephone | 6186432835 |
| Practice Fax Number | 6186432891 |
| Mailing Telephone | 6186432835 |
| Mailing Fax Number | 6186432891 |
| Enumeration Date | 2006-12-14 |
| Last Update Date | 2007-09-18 |
| Authorized Official Name | DEBBIE E BREWER (DIRECTOR OF PROVIDER ENROLLMENT) |
| Authorized Official Telephone | 8778929813 |
| Is Organization Subpart | Y |
| Parent Organization Name | CROSSROADS PHYSICIAN CORP |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363A00000X | Physician Assistant | IL | Physician Assistants & Advanced Practice Nursing Providers | |
| N | 363L00000X | Nurse Practitioner | IL | Physician Assistants & Advanced Practice Nursing Providers | |
| Y | 207R00000X | Internal Medicine | IL | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Crossroads Family Medicine of McLeansboro | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871587881 | Crossroads Physician Corp | Internal Medicine | 1009 S 42nd St, Suite #2, Mount Vernon, IL 62864-6218 | 2005-09-06 |
| 1669466686 | Crossroads Physician Corp | Clinic/Center | 3505 Broadway St, Mount Vernon, IL 62864-2202 | 2005-09-06 |
| 1780678797 | Crossroads Physician Corp | Family Medicine | 209 Crossroads Pl, Suite 120, Mount Vernon, IL 62864-6254 | 2005-09-06 |
| 1972597060 | Crossroads Physician Corp | Physician Assistant | 1209 W Robinson St, Wayne City, IL 62895-9672 | 2005-09-06 |
| 1598759516 | Crossroads Physician Corp | Nurse Practitioner | 1325 W Whittaker St, Suite 3, Salem, IL 62881-2007 | 2005-09-06 |
| 1790779874 | Crossroads Physician Corp | Nurse Practitioner | 4101 N Water Tower Pl, Mount Vernon, IL 62864-6296 | 2005-09-06 |
| 1194980516 | Crossroads Physician Corp | Internal Medicine | 209 Crossroads Pl, Suite 140, Mount Vernon, IL 62864-6545 | 2008-07-24 |
| 1679637789 | Crossroads Physician Corp | Physician Assistant | 1 Doctors Park Rd, Suite C, Mount Vernon, IL 62864-6251 | 2006-12-21 |
| 1699769612 | Crossroads Physician Corp | Family Medicine | 209 Crossroads Pl, Suite 150, Mount Vernon, IL 62864-6254 | 2005-09-06 |
| 1417941436 | Crossroads Physician Corp | Surgery | 209 Crossroads Pl, Suite 130, Mount Vernon, IL 62864-6254 | 2005-09-06 |
| Street Address |
208 S WASHINGTON STREET |
| City | MCLEANSBORO |
| State | IL |
| Zip Code | 62859 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639598220 | Emily Knight | Speech-Language Pathologist | 10499 County Rd. 700 N., Mc Leansboro, IL 62859 | 2014-04-10 |
| 1235422130 | Hamilton Memorial Nursing and Rehabilitation Center, L.L.C. | Skilled Nursing Facility | 609 S Marshall Avenue, Mcleansboro, IL 62859 | 2011-05-25 |
| 1558673152 | Sai Prashanth Babu Palepu | Family Medicine | 611 South Marshall, Mcleansboro, IL 62859 | 2010-07-12 |
| 1831329416 | Nikki Diane Lynch | Occupational Therapy Assistant | Rr3 Box 108, Mcleansboro, IL 62859 | 2009-07-17 |
| 1952576639 | Rci Wrs Inc | Clinic/Center | 208 B South Washington Street, Mcleansboro, IL 62859 | 2008-04-24 |
| 1215110903 | Hamilton County Health Department | Clinic/Center | Courthouse Room 5, Mcleansboro, IL 62859 | 2007-12-17 |
| 1033291034 | Brett Allen Watkins | Chiropractor | 301 S Jackson, Mcleansboro, IL 62859 | 2006-10-19 |
| 1609837665 | Hamilton Memorial Hospital District | Clinic/Center | 611 S Marshall Avenue, Mcleansboro, IL 62859 | 2006-03-30 |
| 1437650116 | Deaconess Specialty Physicians, Inc | Internal Medicine | 206 S Washington St, Mc Leansboro, IL 62859 | 2018-02-27 |
| 1114216686 | Jefferson County Comprehensive Svc | Clinic/Center | Rr 5, Mcleansboro, IL 62859 | 2011-04-05 |
| Find all providers in zip 62859 | ||||
| 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 |
|---|---|---|---|---|
| 1962002832 | Coleman Clinic, Inc. | Internal Medicine | 1893 Daimler Rd Ste A, Rockford, IL 61112-1081 | 2020-10-29 |
| 1922606193 | Thatiana Carolina Schulze Goni | Internal Medicine | 5924 N Lincoln Ave Apt 205, Chicago, IL 60659-3736 | 2020-10-11 |
| 1447866579 | Jashan Gill | Internal Medicine | 3707 Doty Rd Ste Eandf, Woodstock, IL 60098-7530 | 2020-09-23 |
| 1649884636 | Maria Detolve Donoghue | Internal Medicine | 905 Eldorado St, Winnetka, IL 60093-1951 | 2020-09-07 |
| 1750995742 | Eva Bartaula | Internal Medicine | 1500 S Fairfield Ave # 3, Chicago, IL 60608-1782 | 2020-09-07 |
| 1750994513 | Ranjit Babu Jasaraj | Internal Medicine | 1500 S Fairfield Ave # F-914, Chicago, IL 60608-1782 | 2020-08-30 |
| 1871106005 | Vijay Ketan Reddy | Internal Medicine | 1500 S Fairfield Ave Dept Roomf914, Chicago, IL 60608-1782 | 2020-08-27 |
| 1144839739 | Sandhya Shri Kannayiram | Internal Medicine | 1901w Harrison Street, Chicago, IL 60612 | 2020-07-29 |
| 1417566084 | Avani Sushilkumar Mohta | Internal Medicine | Carle Foundation Hospital, 611 W. Park Street, Urbana, IL 61801 | 2020-07-29 |
| 1659989937 | Consultant Physicians | Internal Medicine | 580 Bankview Dr, Frankfort, IL 60423-1382 | 2020-07-22 |
| Find all providers with the same taxonomy | ||||
| City | MCLEANSBORO |
| Zip Code | 62859 |
Please comment or provide details below to improve the information on CROSSROADS PHYSICIAN CORP.
| 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.