ILLINI MEDICAL ASSOCIATES, SC (NPI# 1023143716) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1023143716 |
| Entity Type | Organization |
| Organization Name | ILLINI MEDICAL ASSOCIATES, SC |
| Practice Address |
205 S Morse St Roodhouse IL 62082-1322 |
| Mailing Address |
390 Maple Summit Rd Jerseyville IL 62052-2000 |
| Practice Telephone | 2175894383 |
| Practice Fax Number | 2175894409 |
| Mailing Telephone | 6184987518 |
| Mailing Fax Number | 6184983052 |
| Enumeration Date | 2007-02-22 |
| Last Update Date | 2014-11-19 |
| Authorized Official Name | MICHAEL S MCNEAR (CEO) |
| Authorized Official Telephone | 6184987518 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | BCBS OF ILLINOIS | 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 |
| 1891034294 | Illini Medical Associates, Sc | Pediatrics | 1440 W Walnut St, Ste 2a, Jacksonville, IL 62650-1143 | 2013-02-05 |
| 1821383100 | Illini Medical Associates, Sc | Psychiatry & Neurology | 1170 Wall St, Suite 102, Jacksonville, IL 62650-4053 | 2011-06-14 |
| Street Address |
205 S MORSE ST |
| City | ROODHOUSE |
| State | IL |
| Zip Code | 62082-1322 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083155311 | Kaci N Havlin | Nurse Practitioner | 205 S Morse St, Roodhouse, IL 62082-1322 | 2017-03-20 |
| 1346676012 | Megan M Skolasinski | Physician Assistant | 205 S Morse St, Roodhouse, IL 62082-1322 | 2013-09-25 |
| 1649484072 | Arlene June Norris | Physician Assistant | 205 S Morse St, Roodhouse, IL 62082-1322 | 2007-05-08 |
| 1437280567 | Julie Christian | Physician Assistant | 205 S Morse St, Roodhouse, IL 62082-1322 | 2007-03-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649826603 | Christina Ann Vanmeter | Nurse Practitioner | 302 E North St, Roodhouse, IL 62082-1129 | 2019-08-15 |
| 1760864334 | Amanda Goben | Developmental Therapist | 457 E North St, Roodhouse, IL 62082-1130 | 2015-06-19 |
| 1023198785 | Pharmacy Plus Inc | Durable Medical Equipment & Medical Supplies | 213 W Clay St, Roodhouse, IL 62082-1344 | 2006-10-17 |
| 1831680057 | Kelsie Harris | Nurse's Aide | 202 W Lorton St, Roodhouse, IL 62082-1514 | 2018-05-23 |
| 1770988735 | Jersey Community Hospital | Clinic/Center | 414 S State St, Roodhouse, IL 62082-1544 | 2014-11-03 |
| 1144313180 | Thomas H. Boyd Memorial Hospital | Clinic/Center | 132 W Lorton St, Roodhouse, IL 62082-1569 | 2006-10-02 |
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053911495 | Moataz Barkat | Family Medicine | 3315 W 66th Pl, Chicago, IL 60629-3427 | 2020-10-26 |
| 1558969964 | Nicole Kerner | Family Medicine | 310 Brandy Dr, Mackinaw, IL 61755-9707 | 2020-10-16 |
| 1285232991 | Healthy Medical Inc | Family Medicine | 535 N. East St., Suite A, Bradley, IL 60915 | 2020-10-14 |
| 1558976589 | Jasmine Ashley Fowler | Family Medicine | 2416 N Lotus Ave, Chicago, IL 60639-1435 | 2020-09-15 |
| 1790390805 | Kimberly Hannah Kupferberg | Family Medicine | 1103 Schaeffer Rd, Long Grove, IL 60047-5153 | 2020-09-15 |
| 1194330977 | Home Doctors for You | Family Medicine | 670 Illinois Blvd, Hoffman Est, IL 60169-3363 | 2020-09-09 |
| 1245844489 | Jovita Zalwango Nassolo | Family Medicine | 116 1/2 N Benton St Apt 2d, Woodstock, IL 60098-3272 | 2020-09-04 |
| 1720699176 | Healing Hands Resource Center Streator | Family Medicine | 2128 S Central Park Ave, Chicago, IL 60623-3113 | 2020-08-10 |
| 1417565755 | Ghr Total Health and Consulting | Family Medicine | 11336 Mckenna Dr, Frankfort, IL 60423-8096 | 2020-07-22 |
| 1285251892 | Soe Lwin Oo | Family Medicine | 1625 E 75th St # 1, Chicago, IL 60649-3603 | 2020-06-30 |
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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.