PASSAVANT PHYSICIAN ASSOCIATION (NPI# 1972054609) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1972054609 |
| Entity Type | Organization |
| Organization Name | PASSAVANT PHYSICIAN ASSOCIATION |
| Practice Address |
559 N Westgate Ave Jacksonville IL 62650-1156 |
| Practice Telephone | 2172435474 |
| Practice Fax Number | 2172452322 |
| Mailing Telephone | 2172435474 |
| Mailing Fax Number | 2172452322 |
| Enumeration Date | 2016-10-18 |
| Last Update Date | 2017-04-04 |
| Authorized Official Name | MR. ROBERT ELLISON (DIRECTOR) |
| Authorized Official Telephone | 2174795890 |
| Is Organization Subpart | Y |
| Parent Organization Name | PASSAVANT MEMORIAL AREA HOSPITAL |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians | ||
| N | 207R00000X | Internal Medicine | Allopathic & Osteopathic Physicians | ||
| N | 207Y00000X | Otolaryngology | Allopathic & Osteopathic Physicians | ||
| Y | 261QR1300X |
Clinic/Center Specialization: Rural Health |
Ambulatory Health Care Facilities |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205387958 | Passavant Physician Association | Obstetrics & Gynecology | 1600 W Walnut St, Jacksonville, IL 62650-1136 | 2016-10-18 |
| 1922410836 | Passavant Physician Association | Clinic/Center | 557 N Westgate Ave, Jacksonville, IL 62650-1156 | 2014-05-27 |
| 1841578507 | Passavant Physician Association | Nurse Practitioner | 1600 W Walnut St, Jacksonville, IL 62650-1136 | 2011-07-29 |
| 1720370778 | Passavant Physician Association | Internal Medicine | 559 N Westgate Ave, Jacksonville, IL 62650-1156 | 2011-05-10 |
| 1962689307 | Passavant Physician Association | Family Medicine | 1600 W Walnut St, Jacksonville, IL 62650-1136 | 2008-01-29 |
| Street Address |
559 N WESTGATE AVE |
| City | JACKSONVILLE |
| State | IL |
| Zip Code | 62650-1156 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356393300 | Babu Rao Eladasari | Internal Medicine | 559 N Westgate Ave, Jacksonville, IL 62650-1156 | 2006-05-17 |
| 1184077554 | Hilary L. Boyle | Audiologist | 559 N Westgate Ave, Jacksonville, IL 62650-1156 | 2016-07-20 |
| 1720370778 | Passavant Physician Association | Internal Medicine | 559 N Westgate Ave, Jacksonville, IL 62650-1156 | 2011-05-10 |
| 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 | 261QR1300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Rural Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053804443 | Siu Physicians & Surgeons, Inc | Clinic/Center | 610 N Westgate Ave, Jacksonville, IL 62650-1152 | 2018-06-11 |
| 1861991226 | Jacksonville Hospital LLC | Clinic/Center | 203 Nacogdoches St Ste 280, Jacksonville, TX 75766-2444 | 2018-02-12 |
| 1922410836 | Passavant Physician Association | Clinic/Center | 557 N Westgate Ave, Jacksonville, IL 62650-1156 | 2014-05-27 |
| 1205180056 | Memorial Physician Services | Clinic/Center | 1600 W Walnut St, East Wing, 3rd Floor, Jacksonville, IL 62650-1136 | 2012-11-01 |
| 1104179415 | Memorial Physician Services | Clinic/Center | 1602 W Lafayette Ave, Jacksonville, IL 62650-1007 | 2012-10-24 |
| 1558614867 | Memorial Physician Services | Clinic/Center | 15 Founders Ln, Suite 100, Jacksonville, IL 62650-3919 | 2012-10-24 |
| 1881947174 | Memorial Physician Services | Clinic/Center | 1606 W Lafayette Ave, Jacksonville, IL 62650-3707 | 2012-10-24 |
| 1821366170 | East Texas Medical Center Jacksonville | Clinic/Center | 203 Nacogdoches St, Suite 280, Jacksonville, TX 75766-2444 | 2011-12-01 |
| 1598068793 | Springfield Clinic LLP | Clinic/Center | 15 Founders Ln, Jacksonville, IL 62650-3919 | 2010-12-09 |
| 1619129897 | Jacksonville, LLC | Clinic/Center | 1602 W Lafayette Ave, Jacksonville, IL 62650-1007 | 2008-10-21 |
| Find all providers in JACKSONVILLE | ||||
| City | JACKSONVILLE |
| Zip Code | 62650 |
Please comment or provide details below to improve the information on PASSAVANT PHYSICIAN ASSOCIATION.
| 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.