OMAR MUDALLAL (NPI# 1023369097) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1023369097 |
| Entity Type | Individual |
| Full Name | OMAR MUDALLAL |
| Practice Address |
400 Maple Summit Rd Jerseyville IL 62052-2028 |
| Mailing Address |
7901 Broadway Elmhurst NY 11373-1329 |
| Practice Telephone | 6184986402 |
| Practice Fax Number | 6184988439 |
| Enumeration Date | 2012-09-30 |
| Last Update Date | 2019-05-29 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207R00000X | Internal Medicine | 036147331 | IL | Allopathic & Osteopathic Physicians |
| N | 390200000X | Student in an Organized Health Care Education/Training Program | Student, Health Care |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 7901 Broadway, Elmhurst, NY 113731329 | 7183342490 |
| Street Address |
400 MAPLE SUMMIT RD |
| City | JERSEYVILLE |
| State | IL |
| Zip Code | 62052-2028 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568461523 | Larry Duane Rawlings | Nurse Anesthetist, Certified Registered | 400 Maple Summit Rd, Jerseyville, IL 62052-2028 | 2005-07-20 |
| 1295361533 | Amanda Leigh Ruyle-ryan | Nurse Practitioner | 400 Maple Summit Rd, Jerseyville, IL 62052-2028 | 2020-03-18 |
| 1255981528 | Stacy Rae Marriott | Nurse Practitioner | 400 Maple Summit Rd, Jerseyville, IL 62052-2028 | 2019-09-18 |
| 1659939049 | Erinn E Hileman | Nurse Practitioner | 400 Maple Summit Rd, Jerseyville, IL 62052-2028 | 2019-05-31 |
| 1801359575 | Kristin Anne Kilpatrick | Nurse Practitioner | 400 Maple Summit Rd, Jerseyville, IL 62052-2028 | 2019-04-10 |
| 1710461777 | Jersey Community Hospital | Durable Medical Equipment & Medical Supplies | 400 Maple Summit Rd, Suite 100, Jerseyville, IL 62052-2028 | 2018-09-17 |
| 1922492271 | Julie Ann Jackson | Nurse Practitioner | 400 Maple Summit Rd, Jerseyville, IL 62052-2028 | 2015-03-25 |
| 1508258393 | Lindsey Buckles | Physician Assistant | 400 Maple Summit Rd, Jerseyville, IL 62052-2028 | 2015-03-03 |
| 1114235603 | Advanced Imaging Consultants LLC | Radiology | 400 Maple Summit Rd, Radiology Dept, Jerseyville, IL 62052-2028 | 2010-09-17 |
| 1194950816 | Beth Ann Dalrymple-woods | Nurse Practitioner | 400 Maple Summit Rd, Jerseyville, IL 62052-2028 | 2009-05-26 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396265666 | Lauren Mccarthy | Podiatrist | 400 Maple Summit Rd Suite 200, Jerseyville, IL 62052 | 2017-06-27 |
| 1851757488 | German Insurance Agency | Local Education Agency (LEA) | 850 S State Street, Jerseyville, IL 62052 | 2016-01-12 |
| 1942584230 | Thomas G Honke | Pharmacist | 705 South State, Walgreens, Jerseyville, IL 62052 | 2011-10-05 |
| 1861786493 | Pain Relief Center | Clinic/Center | 903 South State Street, Jerseyville, IL 62052 | 2011-05-31 |
| 1902058845 | Ronald Lee Schroeder | Obstetrics & Gynecology | 1211 West Carpenter, Jerseyville, IL 62052 | 2008-10-22 |
| 1760696116 | Rebecca Elaine Alexander | Massage Therapist | 1301 S State St, Jerseyville, IL 62052 | 2007-05-09 |
| 1205950540 | Charles C Alexander | Chiropractor | 1301 S State, Jerseyville, IL 62052 | 2007-03-19 |
| 1902816358 | Kirk William Schultz | Chiropractor | 519 South State Street, Jerseyville, IL 62052 | 2006-08-08 |
| 1235119652 | Batool N Vali | Obstetrics & Gynecology | 1702 W. County Road, Jerseyville, IL 62052 | 2006-01-20 |
| 1649270729 | Jersey County Health Department | Public Health or Welfare | 1307 State Highway 109, Jerseyville, IL 62052 | 2005-07-29 |
| Find all providers in zip 62052 | ||||
| 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 |
|---|---|---|---|---|
| 1831365881 | S S Kurella Md PC | Internal Medicine | 1011 Edgewood Ave, Jerseyville, IL 62052-1177 | 2008-04-30 |
| 1326034919 | Srirama S Kurella | Internal Medicine | 390 Maple Summit Rd, Jerseyville, IL 62052-2000 | 2005-09-20 |
| 1285682864 | Lester A Crancer | Internal Medicine | 390 Maple Summit Rd, Jerseyville, IL 62052 | 2006-05-05 |
| 1750353454 | Medical Associates of Jerseyville, Ltd. | Internal Medicine | 270 Maple Summit Rd, Mcdow Building, Jerseyville, IL 62052-2004 | 2006-02-06 |
| 1659374239 | Donald E Murray | Internal Medicine | 270 Maple Summit Rd, Jerseyville, IL 62052-2004 | 2005-05-27 |
| 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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| City | JERSEYVILLE |
| Zip Code | 62052 |
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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.