PRAIRIE CARDIOVASCULAR CONSULTANTS, LTD. (NPI# 1982714218) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1982714218 |
| Entity Type | Organization |
| Organization Name | PRAIRIE CARDIOVASCULAR CONSULTANTS, LTD. |
| Practice Address |
3 Saint Elizabeth Blvd Ste 2800 O Fallon IL 62269-1282 |
| Practice Telephone | 6182336044 |
| Practice Fax Number | 6182335195 |
| Mailing Telephone | 6182336044 |
| Mailing Fax Number | 6182335195 |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2019-10-05 |
| Authorized Official Name | MR. EDWARD D BROOKS JR. (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Telephone | 2177880706 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2086S0129X |
Surgery Specialization: Vascular Surgery |
Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | RAILROAD MEDICARE | CI5907 | 01 |
| IL | RAILROAD MEDICARE | CA6852 | 01 |
| IL | RAILROAD MEDICARE | CA3360 | 01 |
| IL | RAILROAD MEDICARE | CC1312 | 01 |
| IL | RAILROAD MEDICARE | CE0750 | 01 |
| Street Address |
3 SAINT ELIZABETH BLVD STE 2800 |
| City | O FALLON |
| State | IL |
| Zip Code | 62269-1282 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265994438 | Michelle Sandlin | Internal Medicine | 3 Saint Elizabeth Blvd Ste 2800, O Fallon, IL 62269-1282 | 2019-04-04 |
| 1609223304 | Deanna Lambert | Internal Medicine | 3 Saint Elizabeth Blvd Ste 2800, O Fallon, IL 62269-1282 | 2016-05-23 |
| 1457526576 | Ashraf Salah Al Dadah | Internal Medicine | 3 Saint Elizabeth Blvd Ste 2800, O Fallon, IL 62269 | 2008-04-29 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326648155 | Kayla Revermann | Pharmacist | 1350 W Us Highway 50, Pharmacy, O Fallon, IL 62269 | 2020-10-30 |
| 1942814272 | Ashley Monique Gibson | Behavior Technician | Eagle Center, Ste 10, Ofallon, IL 62269 | 2020-09-03 |
| 1013533819 | Michelle Denise Voudrie | Registered Nurse | 321 Regency Park, O'fallon, IL 62269 | 2020-06-18 |
| 1598398455 | Washington University Physicians In Illinois - Cancer Center Pharmacy | Pharmacy | 1418 Cross Street, Suite 180, Shiloh, IL 62269 | 2020-02-19 |
| 1962063800 | Gerald Paskert | Pharmacist | 122 W. State St., O'fallon, IL 62269 | 2019-06-21 |
| 1780144808 | Bonnie Jean Lampe | Physical Therapy Assistant | 316 Donna Dr, O'fallon, IL 62269 | 2019-03-24 |
| 1134633993 | Latisha Smith | Psychologist | 600 S. Smiley St., O'fallon, IL 62269 | 2017-11-30 |
| 1619407210 | Brenna M Thomas | Registered Nurse | 1310 Engle Ct, O'fallon, IL 62269 | 2017-06-15 |
| 1881135622 | Pc Associates, LLC | Family Medicine | 800 East Highway 50, O'fallon, IL 62269 | 2017-03-13 |
| 1700230539 | Jennifer Farrell | Family Medicine | 3 St. Elizabeth's Blvd, Ste. 4000, O'fallon, IL 62269 | 2016-04-18 |
| Find all providers in zip 62269 | ||||
| Taxonomy Code | 2086S0129X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Surgery |
| Specialization | Vascular Surgery |
| A surgeon with expertise in the management of surgical disorders of the blood vessels, excluding the intracranial vessels or the heart. |
| 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 Surgery, 2007. http://www.absurgery.org/. American Osteopathic Board of Surgery, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Surgery. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396267324 | Congress Vascular Center LLC | Surgery | 41 W Congress Pkwy Fl 1, Chicago, IL 60605-1531 | 2017-07-11 |
| 1043731300 | Elmwood Park Vascular Center LLC | Surgery | 7230 W North Ave Ste 108, Elmwood Park, IL 60707-4261 | 2017-06-27 |
| 1588105811 | Mickey Graphia | Surgery | 701 N 1st St # D346, Springfield, IL 62702 | 2017-03-20 |
| 1992126668 | Vascular Specialists LLC | Surgery | 20060 Governors Dr Ste 102, Olympia Fields, IL 60461-1099 | 2013-12-26 |
| 1588959548 | Patrick Michael Sullivan Neville | Surgery | 4600 Memorial Dr Ste 120, Belleville, IL 62226-5359 | 2011-06-17 |
| 1235454968 | Margaret Claire Rigamer | Surgery | 1901 W Harrison St Dept Of, Chicago, IL 60612-3714 | 2010-04-06 |
| 1215251541 | John V. White, Md, LLC | Surgery | 8816 W Dempster St, Niles, IL 60714-5109 | 2010-03-15 |
| 1710212733 | Vascular Surgery and Interpretation S.c. | Surgery | 3330 W 177th St Ste 2c1, Hazel Crest, IL 60429-2184 | 2009-10-08 |
| 1538391792 | Usa Vein Clinics of Chicago LLC | Surgery | 4141 Dundee Rd, Northbrook, IL 60062-2129 | 2009-08-20 |
| 1306010731 | Tanq, Inc. | Surgery | 18510 S Marilynn Ct, Mokena, IL 60448-9517 | 2008-04-16 |
| Find all providers with the same taxonomy | ||||
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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.