PEDIATRIC GROUP LLC (NPI# 1023582038) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1023582038 |
| Entity Type | Organization |
| Organization Name | PEDIATRIC GROUP LLC |
| Practice Address |
900 E Walnut St Ste 6 Carbondale IL 62901-3132 |
| Mailing Address |
3412 Office Park Dr Marion IL 62959-6477 |
| Practice Telephone | 6189930404 |
| Practice Fax Number | 6189931717 |
| Mailing Telephone | 6189930404 |
| Mailing Fax Number | 6189930404 |
| Enumeration Date | 2019-01-14 |
| Last Update Date | 2019-01-14 |
| Authorized Official Name | RHONDA LYNN FISHER (OFFICE MANAGER) |
| Authorized Official Telephone | 6189930404 |
| Is Organization Subpart | Y |
| Parent Organization Name | PEDIATRIC GROUP, LLC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208000000X | Pediatrics | Allopathic & Osteopathic Physicians |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114129970 | Pediatric Group LLC | Clinic/Center | 3412 Office Park Drive, Marion, IL 62959-1998 | 2007-06-04 |
| Street Address |
900 E WALNUT ST STE 6 |
| City | CARBONDALE |
| State | IL |
| Zip Code | 62901-3132 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558961268 | Gerad Aaron Harsy | Pharmacist | Walmart Pharmcy, 1450 East Main St, Carbondale, IL 62901 | 2020-10-30 |
| 1437708674 | Board of Trustees of Southern Illinois University | Clinic/Center | 300 W Oak Street, Carbondale, IL 62901 | 2019-09-10 |
| 1306317383 | Rachael O Johnson | Nurse Practitioner | 404 S. Lewis Ln, Carbondale, IL 62901 | 2018-12-17 |
| 1740795194 | Megan Marie Zimmerman | Nurse Practitioner | 1100 W Diann Ln., Carbondale, IL 62901 | 2017-12-07 |
| 1295244242 | Amy Elizabeth Prudencio | Social Worker | 1301 E. Walnut Street, Carbondale, IL 62901 | 2017-09-21 |
| 1740708171 | Theresa Aleise Goodin | Speech-Language Pathologist | 1301 East Walnut Street, Carbondale, IL 62901 | 2017-09-06 |
| 1144762527 | Kathleen Chwalisz Rigney | Psychologist | 306 West Mill Street, Neurorestorative, Carbondale, IL 62901 | 2016-11-16 |
| 1285185173 | Shawnee Health Service and Development Corp | Social Worker | 404 S. Lewis Lane, Carbondale, IL 62901 | 2016-10-17 |
| 1437605094 | Arielle Greer | Nurse's Aide | 510 E. Russell St., A, Carbondale, IL 62901 | 2016-09-01 |
| 1518413863 | Complete Family Eyecare of Carbondale, PC | Optometrist | 1241 East Walnut Street, Carbondale, IL 62901 | 2016-08-28 |
| Find all providers in zip 62901 | ||||
| Taxonomy Code | 208000000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. |
| 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 Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certificatio - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285282137 | Castle Valley Children's Clinic | Pediatrics | 2615 Dolores Way Unit 103, Carbondale, CO 81623-2238 | 2019-09-03 |
| 1336416619 | Wayne Memorial Community Health Centers | Pediatrics | 152 Brooklyn St, Carbondale, PA 18407-2208 | 2011-11-30 |
| 1356586119 | Geisinger Clinic | Pediatrics | 42 North Scott St, Carbondale, PA 18407-0000 | 2008-12-09 |
| 1518009414 | Maxis Medical Services | Pediatrics | 42 N Scott St, Carbondale, PA 18407-1888 | 2007-02-14 |
| 1871517466 | Paul F Ploegman | Pediatrics | 1111 Cedar Ct, Carbondale, IL 62901-5333 | 2006-07-27 |
| 1669445755 | Alexander J Pinsky | Pediatrics | 141 Salem Ave Ste 302, Carbondale, PA 18407-2500 | 2006-02-09 |
| 1255738597 | Amit Sharma | Pediatrics | 405 W Jackson St, Carbondale, IL 62901-1462 | 2014-12-02 |
| 1710225263 | Tomas Ignacio Munoz | Pediatrics | 405 W Jackson St, Carbondale, IL 62901-1462 | 2013-01-17 |
| 1467711796 | Lukasz Dabrowski | Pediatrics | 2601 W Main St, Carbondale, IL 62901-1031 | 2012-05-07 |
| 1881980233 | Izaskun Melania Iglesias | Pediatrics | 101 S Wall St, Carbondale, IL 62901-3021 | 2011-06-23 |
| Find all providers in CARBONDALE | ||||
| City | CARBONDALE |
| Zip Code | 62901 |
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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.