ST. LOUIS JC VAMC (NPI# 1962862342) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1962862342 |
| Entity Type | Organization |
| Organization Name | ST. LOUIS JC VAMC |
| Other Organization Name | MARION VA CARE SITE |
| Practice Address |
2401 W Main St Marion IL 62959-1188 |
| Mailing Address |
Po Box 94462 Cleveland OH 44101-4462 |
| Practice Telephone | 9135784409 |
| Mailing Telephone | 9135784409 |
| Enumeration Date | 2016-02-29 |
| Last Update Date | 2018-01-17 |
| Authorized Official Name | ERIN POTTER (NPI TEAM MEMBER) |
| Authorized Official Telephone | 2023822579 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 323P00000X | Psychiatric Residential Treatment Facility | Residential Treatment Facilities |
| Other Name | Type Code |
|---|---|
| MARION VA CARE SITE | Other Name - Individual/Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114317369 | St. Louis Jc Vamc | Clinic/Center | 2600 Washington Boulevard, St. Louis, MO 63103-1420 | 2015-01-27 |
| 1396135513 | St. Louis Jc Vamc | Clinic/Center | 3615 Olive Street, St. Louis, MO 63108-3604 | 2015-01-26 |
| 1558751776 | St. Louis Jc Vamc | Clinic/Center | 3403 Heartland Street, Marion, IL 62959-6393 | 2015-01-26 |
| 1992067995 | St. Louis Jc Vamc | Clinic/Center | 1130 E Walnut St, Suite 100, Carbondale, IL 62901-5007 | 2012-06-14 |
| 1497012652 | St. Louis Jc Vamc | Clinic/Center | 608 Rollie Moore Drive, Harrisburg, IL 62946-9998 | 2012-04-12 |
| 1902198922 | St. Louis Jc Vamc | Clinic/Center | 1627 A Roy Dr, Washington, MO 63090-5008 | 2011-05-10 |
| 1619116399 | St. Louis Jc Vamc | Clinic/Center | 1253 Paris Rd, Suite A, Mayfield, KY 42066-4989 | 2009-02-19 |
| 1518155878 | St. Louis Jc Vamc | Clinic/Center | 6854 Parker Rd, Florissant, MO 63033-5313 | 2007-10-11 |
| 1578616892 | St. Louis Jc Vamc | Clinic/Center | 99 Stagecoach Rd, Madisonville, KY 42431-8009 | 2007-01-19 |
| 1902840622 | St. Louis Jc Vamc | Clinic/Center | 4105 N Water Tower Pl, Mount Vernon, IL 62864-6296 | 2006-06-15 |
| Street Address |
2401 W MAIN ST |
| City | MARION |
| State | IL |
| Zip Code | 62959-1188 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841277696 | Keith D Stewart | Dentist | 2401 W Main St, Marion, IL 62959-1188 | 2005-12-22 |
| 1396353397 | John Gilmore | Nurse Practitioner | 2401 W Main St, Marion, IL 62959-1188 | 2020-07-16 |
| 1083230098 | Samantha Ann Kimble | Social Worker | 2401 W Main St, Marion, IL 62959-1188 | 2020-06-25 |
| 1659907954 | Jason Patton | Technician | 2401 W Main St, Marion, IL 62959-1188 | 2020-03-18 |
| 1275164543 | Edward Staba | Psychologist | 2401 W Main St, Marion, IL 62959-1188 | 2020-01-27 |
| 1497385918 | Megan Berkel | Technician | 2401 W Main St, Marion, IL 62959-1188 | 2020-01-23 |
| 1699316521 | Angela Trowbridge | Technician | 2401 W Main St, Marion, IL 62959-1188 | 2019-10-02 |
| 1891346276 | Donna Householder | Technician | 2401 W Main St, Marion, IL 62959-1188 | 2019-09-26 |
| 1457902918 | Brenda Frazier | Technician | 2401 W Main St, Marion, IL 62959-1188 | 2019-09-26 |
| 1043861420 | Michelle Collier | Technician | 2401 W Main St, Marion, IL 62959-1188 | 2019-09-26 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710513486 | Sarah Benitone | Counselor | 11264 Il-37, Marion, IL 62959 | 2020-03-13 |
| 1528609328 | Patricia E Murphy | Radiology | 4503 1/2 W Deyoung, Suite 3a, Marion, IL 62959 | 2019-10-02 |
| 1366007007 | Centerstone of Illinois, Inc | Community/Behavioral Health | 202 S Bentley St, Marion, IL 62959 | 2019-05-08 |
| 1649752064 | Sydney Seiter | Occupational Therapist | 906 Skyline Suite 100, Marion, IL 62959 | 2018-09-01 |
| 1497279848 | Brooke Alisa Osman | Licensed Practical Nurse | 11531 Sunderland Road, Marion, IL 62959 | 2017-07-27 |
| 1912436429 | Joy L. Kee | Social Worker | 509 South Bentley Street, Marion, IL 62959 | 2017-06-08 |
| 1386181170 | Susan Smothers | Counselor | 1305 West Main Street, Marion, IL 62959 | 2017-01-31 |
| 1205280922 | Harish Kempegowda | Orthopaedic Surgery | 3331 W Deyoung St Ste 201, Marion, IL 62959 | 2016-04-19 |
| 1942609227 | Casey Hill | Social Worker | 1604 W. Walnut St., Marion, IL 62959 | 2014-08-22 |
| 1306252812 | Justin M White | Chiropractor | 1603 W Kimmel, Marion, IL 62959 | 2014-07-03 |
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| Taxonomy Code | 323P00000X |
| Grouping | Residential Treatment Facilities |
| Classification | Psychiatric Residential Treatment Facility |
| A residential treatment facility (RTF) is a facility or distinct part of a facility that provides to children and adolescents, a total, twenty-four hour, therapeutically planned group living and learning situation where distinct and individualized psychotherapeutic interventions can take place. Residential treatment is a specific level of care to be differentiated from acute, intermediate, and long-term hospital care, when the least restrictive environment is maintained to allow for normalization of the patient’s surroundings. The RTF must be both physically and programmatically distinct if it is a part or subunit of a larger treatment program. An RTF is organized and professionally staffed to provide residential treatment of mental disorders to children and adolescents who have sufficient intellectual potential to respond to active treatment (that is, for whom it can reasonably be assumed that treatment of the mental disorder will result in an improved ability to function outside the RTF) for whom outpatient treatment, partial hospitalization or protected and structured environment is medically or psychologically necessary |
| Notes: Source: Champus Policy manual, Volume II, p. 6010.47M dated 9/12/94. Revision: Definition title revised 7/1/03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245341932 | Applied Mental Health Concepts, Inc | Psychiatric Residential Treatment Facility | 339 N Prospect St, Marion, OH 43302-2364 | 2006-08-31 |
| 1386663516 | Keystone Marion, LLC | Psychiatric Residential Treatment Facility | 225 State St, Marion, VA 24354-3127 | 2006-07-19 |
| 1871953257 | St. Louis Jc Vamc | Psychiatric Residential Treatment Facility | 2401 W Main St, Marion, IL 62959-1188 | 2016-02-29 |
| 1184806432 | Montana Academy, Incorporated | Psychiatric Residential Treatment Facility | 9705 Lost Prairie Rd, Marion, MT 59925-9844 | 2007-11-28 |
| 1275732695 | Keystone Marion, LLC | Psychiatric Residential Treatment Facility | 225 State St, Marion, VA 24354-3127 | 2007-07-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841850476 | Discovery Practice Management, Inc. | Psychiatric Residential Treatment Facility | 1400 E Touhy Ave # 300a, Des Plaines, IL 60018-3305 | 2019-06-17 |
| 1831759653 | Discovery Practice Management, Inc. | Psychiatric Residential Treatment Facility | 1400 E Touhy Ave # 300b, Des Plaines, IL 60018-3305 | 2019-06-14 |
| 1437649266 | Eating Recovery Center | Psychiatric Residential Treatment Facility | 1 E Erie St Ste 400, Chicago, IL 60611-2785 | 2018-05-17 |
| 1588039556 | Bianca Davis | Psychiatric Residential Treatment Facility | 18610 Morris Ave, Homewood, IL 60430-3628 | 2015-12-02 |
| 1992110217 | Insight Behavioral Health Centers | Psychiatric Residential Treatment Facility | 200 E Ohio St, B, Chicago, IL 60611-7269 | 2014-06-25 |
| 1639466915 | Bhc Streamwood Hospital Inc | Psychiatric Residential Treatment Facility | 1360 E Irving Park Rd, Streamwood, IL 60107-3202 | 2011-07-07 |
| 1164751913 | Gpr Solutions Sc | Psychiatric Residential Treatment Facility | 554 Bovidae Cir, Naperville, IL 60565-6184 | 2009-12-08 |
| 1932330446 | Jubilee Health Inc | Psychiatric Residential Treatment Facility | 1016 Victoria Ln, Glendale Heights, IL 60139-4508 | 2009-07-31 |
| 1144427378 | Colin M Hayes | Psychiatric Residential Treatment Facility | 555 Fairview Dr, Office, Rochelle, IL 61068-2310 | 2007-06-29 |
| 1306873419 | Maryville Academy | Psychiatric Residential Treatment Facility | 555 Wilson Lane, Maryville Scott Nolan Center, Des Plaines, IL 60016-4729 | 2006-06-26 |
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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.