PEDIATRIC GROUP LLC (NPI# 1114129970) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1114129970 |
| Entity Type | Organization |
| Organization Name | PEDIATRIC GROUP LLC |
| Practice Address |
3412 Office Park Drive Marion IL 62959-1998 |
| Practice Telephone | 6189930404 |
| Practice Fax Number | 6189931717 |
| Mailing Telephone | 6189930404 |
| Mailing Fax Number | 6189931717 |
| Enumeration Date | 2007-06-04 |
| Last Update Date | 2019-04-30 |
| Authorized Official Name | RHONDA LYNN FISHER (OFFICE MANAGER) |
| Authorized Official Telephone | 6189930404 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 261QR1300X |
Clinic/Center Specialization: Rural Health |
Ambulatory Health Care Facilities | ||
| Y | 2080A0000X |
Pediatrics Specialization: Adolescent Medicine |
Allopathic & Osteopathic Physicians |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 310 W Saint Louis St, West Frankfort, IL 628962037 | 6189930404 | 6189931717 |
| 28 Veterans Dr, Harrisburg, IL 629463320 | 6189930404 | 6189931717 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023582038 | Pediatric Group LLC | Pediatrics | 900 E Walnut St Ste 6, Carbondale, IL 62901-3132 | 2019-01-14 |
| Street Address |
3412 OFFICE PARK DRIVE |
| City | MARION |
| State | IL |
| Zip Code | 62959-1998 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649384892 | Pradeep Gopala Reddy | Pediatrics | 3412 Office Park Drive, Marion, IL 62959-1998 | 2006-08-17 |
| 1104268168 | Carline Mekem Mbeumo | Pediatrics | 3412 Office Park Drive, Marion, IL 62959 | 2013-07-18 |
| 1376683003 | Jeremy Paul Gerwe | Pediatrics | 3412 Office Park Drive, Marion, IL 62959 | 2007-02-08 |
| 1740337237 | Kathy A Herren | Physician Assistant | 3412 Office Park Drive, Marion, IL 62959 | 2007-01-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710513486 | Sarah Benitone | Counselor | 11264 Il-37, Marion, IL 62959 | 2020-03-13 |
| 1528609328 | Patricia E Murphy | Radiology | 4503 1/2 W Deyoung, Suite 3a, Marion, IL 62959 | 2019-10-02 |
| 1366007007 | Centerstone of Illinois, Inc | Community/Behavioral Health | 202 S Bentley St, Marion, IL 62959 | 2019-05-08 |
| 1649752064 | Sydney Seiter | Occupational Therapist | 906 Skyline Suite 100, Marion, IL 62959 | 2018-09-01 |
| 1497279848 | Brooke Alisa Osman | Licensed Practical Nurse | 11531 Sunderland Road, Marion, IL 62959 | 2017-07-27 |
| 1912436429 | Joy L. Kee | Social Worker | 509 South Bentley Street, Marion, IL 62959 | 2017-06-08 |
| 1386181170 | Susan Smothers | Counselor | 1305 West Main Street, Marion, IL 62959 | 2017-01-31 |
| 1205280922 | Harish Kempegowda | Orthopaedic Surgery | 3331 W Deyoung St Ste 201, Marion, IL 62959 | 2016-04-19 |
| 1942609227 | Casey Hill | Social Worker | 1604 W. Walnut St., Marion, IL 62959 | 2014-08-22 |
| 1306252812 | Justin M White | Chiropractor | 1603 W Kimmel, Marion, IL 62959 | 2014-07-03 |
| Find all providers in zip 62959 | ||||
| Taxonomy Code | 2080A0000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| Specialization | Adolescent Medicine |
| A pediatrician who specializes in adolescent medicine is a multi-disciplinary healthcare specialist trained in the unique physical, psychological and social characteristics of adolescents, their healthcare problems and needs. |
| 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/certification - 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 |
|---|---|---|---|---|
| 1093712218 | Cheryl Marsha Greenfield | Pediatrics | 240 Wareham Rd, Marion, MA 02738-1175 | 2005-07-01 |
| 1568514339 | Gleason & Greenfield Pediatrics, PC | Pediatrics | 240 Wareham Rd, Marion, MA 02738-1175 | 2007-01-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417259979 | Adolescent and Young Adult Place Ltd | Pediatrics | 9 N Cicero Ave, Chicago, IL 60644-3602 | 2010-12-03 |
| 1942520671 | Cherie Priya Dhar | Pediatrics | 1440 N Dayton St Fl 3, Chicago, IL 60642-2644 | 2010-06-04 |
| 1730334764 | Neighborhood Pedicatrics Sc | Pediatrics | 20200 Governors Dr, 101, Olympia Fields, IL 60461-1032 | 2008-11-18 |
| 1790950244 | Kids Place of Willowbrool Sc | Pediatrics | 6727 Kingery Hwy, Willowbrook, IL 60527-5142 | 2008-04-25 |
| 1841475746 | David C. Norman, Md Inc. | Pediatrics | 4600 Memorial Dr Ste G60, Belleville, IL 62226-5366 | 2008-01-09 |
| 1346429859 | Pediatric & Adolescent Center, S.c. | Pediatrics | 125 E Lake Cook Rd Ste 107, Buffalo Grove, IL 60089-4394 | 2007-10-31 |
| 1649475377 | Lisa Kantz Simons | Pediatrics | 225 E Chicago Ave # Ms 161b, Chicago, IL 60611-2991 | 2007-06-21 |
| 1346368487 | Sarah Bush Lincoln Health Center | Pediatrics | 1411 E St, Suite 2, Charleston, IL 61920-2529 | 2007-03-27 |
| 1558402958 | Ashok H Bhaskar | Pediatrics | 2250 Weber Rd, Crest Hill, IL 60435-0928 | 2007-02-09 |
| 1609927417 | Kimberly A Seipel-carrow | Pediatrics | Northwestern University Health Services, 633 Emerson, Evanston, IL 60208-0001 | 2007-01-16 |
| 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.