CARLE WEST PHYSICIAN GROUP INC (NPI# 1467074138) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1467074138 |
| Entity Type | Organization |
| Organization Name | CARLE WEST PHYSICIAN GROUP INC |
| Practice Address |
1302 Franklin Ave Ste 3400 Normal IL 61761-6523 |
| Mailing Address |
611 W Park St Urbana IL 61801-2529 |
| Practice Telephone | 3095568295 |
| Mailing Telephone | 2173836792 |
| Mailing Fax Number | 2173834752 |
| Enumeration Date | 2020-05-15 |
| Last Update Date | 2020-05-15 |
| Authorized Official Name | JAMES C LEONARD (PRESIDENT) |
| Authorized Official Telephone | 2173833468 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians |
| Street Address |
1302 FRANKLIN AVE STE 3400 |
| City | NORMAL |
| State | IL |
| Zip Code | 61761-6523 |
| 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 | 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 |
|---|---|---|---|---|
| 1023472636 | Ashraf Abdeljaber | Family Medicine | 1304 Franklin Ave Ste 380, Normal, IL 61761-3558 | 2016-04-09 |
| 1467834317 | Karen Akemi Sung Putty | Family Medicine | 1300 Franklin Ave Ste 110, Normal, IL 61761-3799 | 2015-06-26 |
| 1629311220 | Gbemisola Tolulope Olorode | Family Medicine | 1300 Franklin Ave Ste 380, Normal, IL 61761-4266 | 2013-04-02 |
| 1922206929 | Elaine Welch | Family Medicine | 2200 Fort Jesse Rd Ste 110, Normal, IL 61761-6286 | 2007-07-11 |
| 1083724405 | James Steven Vales | Family Medicine | 109 Veronica Way, Normal, IL 61761-1854 | 2006-08-30 |
| 1972619526 | Todd Owen Kettering | Family Medicine | 1300 Franklin Avenue, Suite 100, Normal, IL 61761 | 2006-08-23 |
| 1548288327 | Marcia K. Hauter | Family Medicine | 1302 Franklin Ave Lowr Level, Normal, IL 61761-3551 | 2006-07-18 |
| 1740207109 | Bromenn Physicians Management Corporation | Family Medicine | 403 W Virginia Ave, Normal, IL 61761-3666 | 2006-07-15 |
| 1790744555 | Victoria J Brockhouse | Family Medicine | 2540 College and University, Normal, IL 61790-2540 | 2006-03-21 |
| 1164422663 | Timothy J Buffey | Family Medicine | 1300 Franklin Ave, Suite 100, Normal, IL 61761-3592 | 2005-07-26 |
| Find all providers in NORMAL | ||||
Please comment or provide details below to improve the information on CARLE WEST PHYSICIAN GROUP INC.
| 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.