DR. CARLOS ALBERTO URDININEA KIRKWOOD (NPI# 1003120783) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1003120783 |
| Entity Type | Individual |
| Full Name | DR. CARLOS ALBERTO URDININEA KIRKWOOD |
| Credential | M.D. |
| Practice Address |
615 N Promenade St Havana IL 62644-1243 |
| Mailing Address |
Po Box 530 Havana IL 62644-0530 |
| Practice Telephone | 3095436600 |
| Mailing Telephone | 3095436600 |
| Mailing Fax Number | 3095432089 |
| Enumeration Date | 2010-08-04 |
| Last Update Date | 2017-01-27 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207R00000X | Internal Medicine | 125058668 | IL | Allopathic & Osteopathic Physicians |
| Street Address |
615 N PROMENADE ST |
| City | HAVANA |
| State | IL |
| Zip Code | 62644-1243 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063478782 | Mason Hospital District | Clinic/Center | 615 N Promenade St, Havana, IL 62644-1243 | 2006-04-21 |
| 1912418799 | Chase Holtman | Nurse Practitioner | 615 N Promenade St, Havana, IL 62644-1243 | 2017-10-19 |
| 1235674946 | Sarah Knake | Registered Nurse | 615 N Promenade St, Havana, IL 62644-1243 | 2017-01-04 |
| 1821472044 | Kathryn Fry | Nurse Practitioner | 615 N Promenade St, Havana, IL 62644-1243 | 2015-07-17 |
| 1790172583 | Hshs Medical Group Inc | Durable Medical Equipment & Medical Supplies | 615 N Promenade St, Havana, IL 62644-1243 | 2015-04-20 |
| 1033524350 | Kayla R Miller | Internal Medicine | 615 N Promenade St, Havana, IL 62644-1243 | 2014-06-25 |
| 1760811434 | Gail Behrends | Dietitian, Registered | 615 N Promenade St, Havana, IL 62644-1243 | 2013-11-04 |
| 1306180203 | Kristi A White | Occupational Therapist | 615 N Promenade St, Havana, IL 62644-1243 | 2012-11-15 |
| 1528312626 | Mason District Hospital | General Acute Care Hospital | 615 N Promenade St, Havana, IL 62644-1243 | 2012-10-29 |
| 1467702985 | Megan Wilson | Specialist/Technologist | 615 N Promenade St, Havana, IL 62644-1243 | 2012-09-12 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982771218 | Mason County Health Department | Clinic/Center | 1002 East Laurel Avenue, Havana, IL 62644 | 2006-11-30 |
| 1346206315 | Havana Hco, LLC | Skilled Nursing Facility | 609 N Harpham St, Havana, IL 62644 | 2006-04-26 |
| 1427561489 | Brandi Nicole Behymer | Nurse's Aide | 320 N Plum St, Havana, IL 62644-1127 | 2017-11-13 |
| 1225032071 | R & Q Corporation | Pharmacy | 201 W Main St, Havana, IL 62644-1137 | 2005-06-09 |
| 1639655616 | Home Dialysis Therapies, Inc | Clinic/Center | 216 W Main St, Havana, IL 62644-1138 | 2018-07-12 |
| 1750382990 | Anthony Dale Roberts | Chiropractor | 303 W Main St, Havana, IL 62644-1139 | 2005-08-10 |
| 1962816868 | John Stinauer | Dentist | 312 W Main St, Havana, IL 62644-1140 | 2014-06-18 |
| 1831469998 | Bleem Family Chiropractic Inc | Chiropractor | 314 W Main St, Havana, IL 62644-1140 | 2012-01-06 |
| 1366751331 | Robert Frank Stinauer | Dentist | 312 W Main St, Havana, IL 62644-1140 | 2010-09-24 |
| 1265663694 | Pam Herrick Counseling, S.c. | Counselor | 314 W Main St, Suite A, Havana, IL 62644-1140 | 2009-08-03 |
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| 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 |
|---|---|---|---|---|
| 1033524350 | Kayla R Miller | Internal Medicine | 615 N Promenade St, Havana, IL 62644-1243 | 2014-06-25 |
| 1801953724 | Daniel Patrick Stoops | Internal Medicine | 615 N Promenade St, Havana, IL 62644-1243 | 2007-01-02 |
| 1861458952 | Richard W Wagoner | Internal Medicine | 615 N Promenade St, Havana, IL 62644-1243 | 2006-04-26 |
| 1245296979 | Tad A Yetter | Internal Medicine | 615 N Promenade St, Havana, IL 62644-1015 | 2006-04-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962002832 | Coleman Clinic, Inc. | Internal Medicine | 1893 Daimler Rd Ste A, Rockford, IL 61112-1081 | 2020-10-29 |
| 1922606193 | Thatiana Carolina Schulze Goni | Internal Medicine | 5924 N Lincoln Ave Apt 205, Chicago, IL 60659-3736 | 2020-10-11 |
| 1447866579 | Jashan Gill | Internal Medicine | 3707 Doty Rd Ste Eandf, Woodstock, IL 60098-7530 | 2020-09-23 |
| 1649884636 | Maria Detolve Donoghue | Internal Medicine | 905 Eldorado St, Winnetka, IL 60093-1951 | 2020-09-07 |
| 1750995742 | Eva Bartaula | Internal Medicine | 1500 S Fairfield Ave # 3, Chicago, IL 60608-1782 | 2020-09-07 |
| 1750994513 | Ranjit Babu Jasaraj | Internal Medicine | 1500 S Fairfield Ave # F-914, Chicago, IL 60608-1782 | 2020-08-30 |
| 1871106005 | Vijay Ketan Reddy | Internal Medicine | 1500 S Fairfield Ave Dept Roomf914, Chicago, IL 60608-1782 | 2020-08-27 |
| 1144839739 | Sandhya Shri Kannayiram | Internal Medicine | 1901w Harrison Street, Chicago, IL 60612 | 2020-07-29 |
| 1417566084 | Avani Sushilkumar Mohta | Internal Medicine | Carle Foundation Hospital, 611 W. Park Street, Urbana, IL 61801 | 2020-07-29 |
| 1659989937 | Consultant Physicians | Internal Medicine | 580 Bankview Dr, Frankfort, IL 60423-1382 | 2020-07-22 |
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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.