CROSSROADS PHYSICIAN CORP (NPI# 1790779874) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1790779874 |
| Entity Type | Organization |
| Organization Name | CROSSROADS PHYSICIAN CORP |
| Other Organization Name | CROSSROADS INTERNAL MEDICINE #1 |
| Practice Address |
4101 N Water Tower Pl Mount Vernon IL 62864-6296 |
| Practice Telephone | 6182444313 |
| Practice Fax Number | 6182449592 |
| Mailing Telephone | 6182444313 |
| Mailing Fax Number | 6182449592 |
| Enumeration Date | 2005-09-06 |
| Last Update Date | 2007-10-30 |
| Authorized Official Name | DEBBIE T BREWER (DIRECTOR OF PROVIDER ENROLLMENT) |
| Authorized Official Telephone | 6154657626 |
| Is Organization Subpart | Y |
| Parent Organization Name | CROSSROADS PHYSICIAN CORP |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363L00000X | Nurse Practitioner | IL | Physician Assistants & Advanced Practice Nursing Providers | |
| Y | 207R00000X | Internal Medicine | IL | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Crossroads Internal Medicine #1 | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366504888 | Crossroads Physician Corp | Physician Assistant | 208 S Washington Street, Mcleansboro, IL 62859 | 2006-12-14 |
| 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 |
| 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 |
4101 N WATER TOWER PL |
| City | MOUNT VERNON |
| State | IL |
| Zip Code | 62864-6296 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447814405 | National Healthcare of Mt Vernon Inc | Clinic/Center | 4101 N Water Tower Pl, Mount Vernon, IL 62864-6296 | 2019-04-25 |
| 1841785185 | Cynthia Dawn Phillips | Nurse Practitioner | 4101 N Water Tower Pl, Mount Vernon, IL 62864-6296 | 2018-06-28 |
| 1255724043 | National Healthcare of Mt. Vernon, Inc | Internal Medicine | 4101 N Water Tower Pl, Mount Vernon, IL 62864-6296 | 2015-03-18 |
| 1013334556 | Sikarin Upala | Internal Medicine | 4101 N Water Tower Pl, Mount Vernon, IL 62864 | 2014-03-22 |
| 1043637580 | Anawin Sanguankeo | Internal Medicine | 4101 N Water Tower Pl, Mount Vernon, IL 62864 | 2014-03-22 |
| 1528233681 | Megan Jean Neely | Internal Medicine | 4101 N Water Tower Pl, Mount Vernon, IL 62864-6296 | 2008-04-29 |
| 1578513420 | William D Huffstutler | Internal Medicine | 4101 N Water Tower Pl, Mount Vernon, IL 62864-6296 | 2006-05-11 |
| 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 | 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 |
|---|---|---|---|---|
| 1912359332 | Narasimha Rao Vattikunta | Internal Medicine | 41 W Sidney Ave, Mount Vernon, Mount Vernon, NY 10550-1954 | 2016-07-09 |
| 1477968337 | Navdeep Dhaliwal | Internal Medicine | 1415 E Kincaid St Dept Of, Mount Vernon, WA 98274-4126 | 2014-06-30 |
| 1043579527 | Maruti Sharma | Internal Medicine | 105 Stevens Ave Ste 208, Mount Vernon, NY 10550 | 2012-05-03 |
| 1235309527 | Mohamed Ruzaik Ibrahim | Internal Medicine | 4115 S Water Tower Pl, Mount Vernon, IL 62864-6293 | 2008-03-03 |
| 1699970202 | Michael Finkelstein, M.d | Internal Medicine | 12 N 7th Ave Fl 5, Mount Vernon, NY 10550-2026 | 2007-06-15 |
| 1801962709 | Carl Joseph Dangio | Internal Medicine | 395 Westchester Avenue, Private House, Mount Vernon, NY 10552-3012 | 2006-11-24 |
| 1629149562 | Manzoor Bhatti | Internal Medicine | 445 Gramatan Ave, Mount Vernon, NY 10552-2931 | 2006-11-13 |
| 1972684173 | Robert Edward Rodstrom | Internal Medicine | 1451 Yauger Rd. 1f, Mount Vernon, OH 43050 | 2006-10-17 |
| 1477656304 | Mark D. Baldwin | Internal Medicine | 819 South 13th Street, Mount Vernon, WA 98273 | 2006-09-06 |
| 1760499594 | Shailesh C Patel | Internal Medicine | 812 Coshocton Avenue, Mount Vernon, OH 43050 | 2006-08-02 |
| Find all providers in MOUNT VERNON | ||||
| City | MOUNT VERNON |
| Zip Code | 62864 |
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.