ILLINI MEDICAL ASSOCIATES, SC (NPI# 1891034294) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1891034294 |
| Entity Type | Organization |
| Organization Name | ILLINI MEDICAL ASSOCIATES, SC |
| Practice Address |
1440 W Walnut St Ste 2a Jacksonville IL 62650-1143 |
| Mailing Address |
390 Maple Summit Rd Jerseyville IL 62052-2000 |
| Practice Telephone | 2173433543 |
| Practice Fax Number | 2173432323 |
| Mailing Telephone | 6184987518 |
| Mailing Fax Number | 6186390385 |
| Enumeration Date | 2013-02-05 |
| Last Update Date | 2013-02-06 |
| Authorized Official Name | DR. MICHAEL S MCNEAR (CHIEF OPERATING OFFICER) |
| Authorized Official Telephone | 6184987518 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208000000X | Pediatrics | 036103709 | IL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | BCBS OF IL | 4215006 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578901930 | Illini Medical Associates, Sc | Durable Medical Equipment & Medical Supplies | 390 Maple Summit Rd, Jerseyville, IL 62052-2000 | 2013-06-07 |
| 1821383100 | Illini Medical Associates, Sc | Psychiatry & Neurology | 1170 Wall St, Suite 102, Jacksonville, IL 62650-4053 | 2011-06-14 |
| 1023143716 | Illini Medical Associates, Sc | Family Medicine | 205 S Morse St, Roodhouse, IL 62082-1322 | 2007-02-22 |
| Street Address |
1440 W WALNUT ST STE 2A |
| City | JACKSONVILLE |
| State | IL |
| Zip Code | 62650-1143 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770576829 | Peter Damon Russotto | Podiatrist | 1440 W Walnut St, #5, Jacksonville, IL 62650-1143 | 2005-08-24 |
| 1972023117 | Ethan Duewer | Dentist | 1440 W Walnut St, Jacksonville, IL 62650-1143 | 2017-06-20 |
| 1205282936 | Central Counties Health Centers, Inc. | Physician Assistant | 1440 W Walnut St, Suite 2, Jacksonville, IL 62650-1143 | 2016-05-12 |
| 1114322286 | Jersey Community Hospital | Pediatrics | 1440 W Walnut St, Suite 2a, Jacksonville, IL 62650-1143 | 2014-10-30 |
| 1558480418 | Physical Therapists Clinic,ltd | Clinic/Center | 1440 W Walnut St, Suite 2, Jacksonville, IL 62650-1143 | 2007-03-29 |
| 1083769475 | Physical Therapists Clinic, Ltd | Physical Therapist | 1440 W Walnut St, Suite2, Jacksonville, IL 62650-1143 | 2007-01-24 |
| 1174608533 | Donald Robert Beckett Jr. | Dentist | 1440 W Walnut St, Suite 2, Jacksonville, IL 62650 | 2006-10-26 |
| 1336179712 | Amy Jo Blanford | Physical Therapist | 1440 W Walnut St, Building #2, Jacksonville, IL 62650-1143 | 2006-07-03 |
| 1245203439 | Linda V Stevens-schilsky | Pediatrics | 1440 W Walnut St, Jacksonville, IL 62650 | 2006-02-09 |
| 1043299803 | Abby G Henry | Physical Therapist | 1440 W Walnut St, #2, Jacksonville, IL 62650-1143 | 2006-01-11 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134768708 | Stephanie Lee Mabus | Occupational Therapy Assistant | 873 Gorve St, Jacksonville, IL 62650 | 2019-12-31 |
| 1285281071 | Sharshon Pharmacy Inc | Pharmacy | 154 W Morton Ave, Jacksonville, IL 62650 | 2019-08-26 |
| 1992275499 | Brittany Ruth Helmich | Counselor | 340 W. State St., Jacksonville, IL 62650 | 2018-11-28 |
| 1811391782 | Rodney E. Overstreet | Hearing Instrument Specialist | 1521 W. Walnut, Jacksonville, IL 62650 | 2014-10-21 |
| 1407979818 | Jan Ala | Speech-Language Pathologist | 1111 W Morton, Speechworks, Jacksonville, IL 62650 | 2007-04-09 |
| 1083787592 | Eldon G Barrowes Dds & Assoc PC | Dentist | 1515 West Walnut, Bldg #3, Jacksonville, IL 62650 | 2006-11-15 |
| 1194895979 | Joseph J Kozma | Internal Medicine | 1440 West Walnut, Jacksonville, IL 62650 | 2006-11-08 |
| 1740350529 | Susan Weller | Dentist | 1614 West Lafayette Avenue, Jackson, IL 62650 | 2006-11-08 |
| 1659467793 | Shawn M Fry | Family Medicine | 610 N. Westgate, Jacksonville, IL 62650 | 2006-10-05 |
| 1518050061 | Ward Richard Dunseth II | Nurse Anesthetist, Certified Registered | 1400 W Walnut, Jacksonville, IL 62650 | 2006-10-02 |
| Find all providers in zip 62650 | ||||
| Taxonomy Code | 208000000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certificatio - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396369187 | Im Sulzbacher Center for The Homeless, Inc | Pediatrics | 5455 Springfield Blvd, Jacksonville, FL 32208-5166 | 2020-06-08 |
| 1609334515 | Jeremy N Harris, M.d., P.a. | Pediatrics | 3636 University Blvd S Ste B3, Jacksonville, FL 32216-4223 | 2019-03-10 |
| 1851856975 | Aksharbrahma Pa | Pediatrics | 6100 Greenland Rd Ste 301, Jacksonville, FL 32258-2626 | 2019-02-02 |
| 1184116972 | North Florida Pediatrics, Pa | Pediatrics | 9770 Old Bay Meadows Road, Suite 101, Jacksonville, FL 32256-7986 | 2018-06-06 |
| 1235654781 | Gabriella Assi, Md, LLC | Pediatrics | 5851 Saint Augustine Rd, Jacksonville, FL 32207-8015 | 2017-08-06 |
| 1417478629 | Johana Beatriz Gimenez | Pediatrics | 15 Founders Ln Ste 100, Jacksonville, IL 62650-3924 | 2017-06-28 |
| 1386185932 | Myrna B Ginter | Pediatrics | 3805 Ortega Blvd, Jacksonville, FL 32210-4415 | 2017-03-15 |
| 1831639400 | Children's Health Associates | Pediatrics | 3710 Grandy Ave, Jacksonville, FL 32207-6112 | 2017-03-02 |
| 1770039687 | Hampton Pediatrics Pa | Pediatrics | 11512 Lake Mead Ave Unit 201, Jacksonville, FL 32256-9688 | 2016-08-30 |
| 1447508478 | Starfish Pediatrics Pa | Pediatrics | 4500 Hodges Blvd, Suite 1, Jacksonville, FL 32224-2207 | 2012-08-23 |
| Find all providers in JACKSONVILLE | ||||
| City | JACKSONVILLE |
| Zip Code | 62650 |
Please comment or provide details below to improve the information on ILLINI MEDICAL ASSOCIATES, SC.
| 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.