LYLE D PAHNKE JR. (NPI# 1770538225) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1770538225 |
| Entity Type | Individual |
| Full Name | LYLE D PAHNKE JR. |
| Credential | MD |
| Practice Address |
302 Broadway St Mount Vernon IL 62864-5116 |
| Practice Telephone | 6182424750 |
| Practice Fax Number | 6182427674 |
| Mailing Telephone | 6182424750 |
| Mailing Fax Number | 6182427674 |
| Enumeration Date | 2006-05-23 |
| Last Update Date | 2017-11-29 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | 036089773 | IL | Allopathic & Osteopathic Physicians |
| N | 208600000X | Surgery | 036089773 | IL | Allopathic & Osteopathic Physicians |
| N | 2086S0129X |
Surgery Specialization: Vascular Surgery |
036089773 | IL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | RR MEDICARE NUMBER | P00169541 | 01 |
| IL | 036089773 | 05 | |
| IL | RR GROUP NUMBER | CG2264 | 01 |
| IL | GROUP | 207988 | 01 |
| Street Address |
302 BROADWAY ST |
| City | MOUNT VERNON |
| State | IL |
| Zip Code | 62864-5116 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679539019 | John Gordon Rowe | Orthopaedic Surgery | 302 Broadway St, Mount Vernon, IL 62864 | 2006-04-25 |
| 1508338872 | Megan Sarah Chillson | Occupational Therapist | 302 Broadway St, Mount Vernon, IL 62864 | 2018-12-26 |
| 1386890234 | Juan Alfredo Carrillo | Orthopaedic Surgery | 302 Broadway St, Mount Vernon, IL 62864-5116 | 2008-08-12 |
| 1538272190 | Alan L Froehling | Orthopaedic Surgery | 302 Broadway St, Mount Vernon, IL 62864-5116 | 2006-08-17 |
| 1114030640 | Neuromuscular Orthopaedic Institute Ltd | Orthopaedic Surgery | 302 Broadway St, Mount Vernon, IL 62864-5116 | 2006-08-17 |
| 1376656827 | Joey Alan Wegmann | Physician Assistant | 302 Broadway St, Mount Vernon, IL 62864-5116 | 2006-08-17 |
| 1316990138 | Sarah Elizabeth Nelson | Occupational Therapist | 302 Broadway St, Mount Vernon, IL 62864-5116 | 2006-05-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619438892 | Melissa Pryer | Dietitian, Registered | 2020 Broadway, Suite 1, Mt. Vernon, IL 62864 | 2019-03-28 |
| 1487145454 | Chiropractic Wellness Center of Mt Vernon, LLC. | Chiropractor | 1009 S 42nd St Ste 5, Mount Vernon, IL 62864 | 2018-05-24 |
| 1851889208 | Kimberly Tate | Counselor | 4110 North Water Place, Mt. Vernon, IL 62864 | 2018-05-01 |
| 1871907790 | University Hematology Oncology Inc | Specialist | #11 Cusumano Professional Plaza, Mount Vernon, IL 62864 | 2014-06-18 |
| 1457771677 | Dynamic Counseling and Consultation Services | Social Worker | 3600 S Water Tower Pl, Mt Vernon, IL 62864 | 2014-04-27 |
| 1619239431 | Judith C Morgan | Counselor | 16338 N Illinois Hwy 37, Mount Vernon, IL 62864 | 2012-06-08 |
| 1073888624 | James Brian Verges | Counselor | 16338 N. Illinois Hwy 37, Mount Vernon, IL 62864 | 2012-03-15 |
| 1720352271 | Lucinda M. Holdren | Counselor | 16338 North Illinois Highway 37, Mount Vernon, IL 62864 | 2012-03-01 |
| 1780978627 | Jamie M Orange | Physical Therapy Assistant | 19958 Fairfield Rd, Mt. Vernon, IL 62864 | 2011-06-08 |
| 1780978791 | Wendy Marie Claytor | Speech-Language Pathologist | 600 E Il Hwy 15, Mount Vernon, IL 62864 | 2011-06-07 |
| Find all providers in zip 62864 | ||||
| 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 |
|---|---|---|---|---|
| 1669084299 | Jean Woel Latortue | Family Medicine | 506 State Tx Hwy 37, Mount Vernon, TX 75457 | 2020-08-17 |
| 1144693250 | David B. Benson, Md, Pllc | Family Medicine | 1603 S 3rd St, Mount Vernon, WA 98273-4909 | 2015-11-11 |
| 1245617828 | Choudhry Nadeem Mumtaz | Family Medicine | 209 Crossroads Pl Ste 120, Mount Vernon, IL 62864-6545 | 2015-05-02 |
| 1801221403 | Docrx, Inc. | Family Medicine | 4200 Williamson Pl, Mount Vernon, IL 62864-6705 | 2013-09-13 |
| 1457605909 | Docrx Inc | Family Medicine | 209 Crossroads Pl Ste 100, Mount Vernon, IL 62864-6545 | 2012-11-06 |
| 1427310473 | Jonathan Titus Hardin | Family Medicine | 1330 Coschocton Road, Mount Vernon, OH 43050 | 2012-06-14 |
| 1760750467 | Lower Oconee Community Hospital, Inc. | Family Medicine | 421 W Robinson Drive, Mount Vernon, GA 30445 | 2011-12-08 |
| 1336435049 | Benjamin Mclaughlin | Family Medicine | 819 S 13th St, Mount Vernon, WA 98274-4112 | 2011-06-21 |
| 1851600845 | Janet K Christiansen | Family Medicine | 13301 Egbers Kalso Rd, Mount Vernon, WA 98273-8207 | 2010-09-25 |
| 1538483722 | Lynette Marie Emery | Family Medicine | 17879 Valley Ridge Ln, Mount Vernon, WA 98274-7743 | 2010-03-17 |
| Find all providers in MOUNT VERNON | ||||
| City | MOUNT VERNON |
| Zip Code | 62864 |
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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.