SPECIALTY PHYSICIANS OF ILLINOIS, LLC (NPI# 1124075676) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1124075676 |
| Entity Type | Organization |
| Organization Name | SPECIALTY PHYSICIANS OF ILLINOIS, LLC |
| Other Organization Name | WELLGROUP HEALTH PARTNERS, LLC |
| Practice Address |
1040 Sierra Dr Ste 400 Greenwood IN 46143-7241 |
| Mailing Address |
1040 Sierra Dr Suite 400 Greenwood IN 46143-7240 |
| Practice Telephone | 3175284291 |
| Mailing Telephone | 3175284253 |
| Mailing Fax Number | 3178658319 |
| Enumeration Date | 2006-05-30 |
| Last Update Date | 2019-09-24 |
| Authorized Official Name | BRAD JOUBERT (DIRECTOR) |
| Authorized Official Telephone | 3175284291 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207K00000X | Allergy & Immunology | Allopathic & Osteopathic Physicians | ||
| N | 207N00000X | Dermatology | Allopathic & Osteopathic Physicians | ||
| N | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians | ||
| N | 207U00000X | Nuclear Medicine | Allopathic & Osteopathic Physicians | ||
| N | 207V00000X | Obstetrics & Gynecology | Allopathic & Osteopathic Physicians | ||
| N | 207W00000X | Ophthalmology | Allopathic & Osteopathic Physicians | ||
| N | 207X00000X | Orthopaedic Surgery | Allopathic & Osteopathic Physicians | ||
| N | 207Y00000X | Otolaryngology | Allopathic & Osteopathic Physicians | ||
| N | 208000000X | Pediatrics | Allopathic & Osteopathic Physicians | ||
| N | 2084N0400X |
Psychiatry & Neurology Specialization: Neurology |
Allopathic & Osteopathic Physicians | ||
| N | 2085R0202X |
Radiology Specialization: Diagnostic Radiology |
Allopathic & Osteopathic Physicians | ||
| N | 2085U0001X |
Radiology Specialization: Diagnostic Ultrasound |
Allopathic & Osteopathic Physicians | ||
| N | 208600000X | Surgery | Allopathic & Osteopathic Physicians | ||
| N | 208800000X | Urology | Allopathic & Osteopathic Physicians | ||
| Y | 207R00000X | Internal Medicine | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | MEDICARE PTAN | 203979 | 01 |
| Other Name | Type Code |
|---|---|
| WellGroup Health Partners, LLC | Former Legal Business Name - Organization |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 3700 W 203rd St, Suite 200, Olympia Fields, IL 604611180 | 7086792013 | 7085033295 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962024612 | Specialty Physicians of Illinois, LLC | Clinic/Center | 20180 S Lagrange Rd, Frankfort, IL 60423-3153 | 2020-05-15 |
| Street Address |
1040 SIERRA DR STE 400 |
| City | GREENWOOD |
| State | IN |
| Zip Code | 46143-7241 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508153206 | Monticello Medical Center | Clinic/Center | 1040 Sierra Dr Ste 400, Greenwood, IN 46143-7241 | 2011-07-01 |
| 1225327984 | Franciscan Physician Network | Internal Medicine | 1040 Sierra Dr Ste 400, Greenwood, IN 46143-7241 | 2011-04-04 |
| 1588673560 | Glhs Anesthesia Group | Anesthesiology | 1040 Sierra Dr Ste 400, Greenwood, IN 46143-7241 | 2006-08-07 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891395299 | Tiffany Smirat | Pharmacist | 882 S Sr 135, Greenwood, IN 46143 | 2020-10-27 |
| 1083250138 | Benajmin Thomas Nyboer | Pharmacist | 5961 North State Road 135, Kroger Pharmacy, Greenwood, IN 46143 | 2019-11-25 |
| 1609417260 | Orthopaedics-indianapolis, Inc | Orthopaedic Surgery | 1579 Olive Branch Parke Lane, Suite 130, Greenwood, IN 46143 | 2019-10-04 |
| 1194282525 | Homebased Mental Health Service | Case Management | 2244 Blossom Dr, Greenwood, IN 46143 | 2019-02-21 |
| 1710478078 | Anne E Packard | Pharmacist | 333 E County Line Rd # 101, Greenwood, IN 46143 | 2018-05-22 |
| 1033607924 | Ez Clinic Inc. | Nurse Practitioner | 494 S Emerson Ave Ste I, Greenwood, IN 46143 | 2018-04-25 |
| 1891246633 | Kroger Limited Partnership I | Durable Medical Equipment & Medical Supplies | 5961 N Sr 135, Greenwood, IN 46143 | 2016-10-17 |
| 1477919637 | Ourhealth Physicians Group, LLC | Clinic/Center | 1273 N Emerson Ave Ste H, Greenwood, IN 46143 | 2016-01-04 |
| 1003212655 | American Health Network of Indiana, LLC | Non-Pharmacy Dispensing Site | 2355 Endress Place St A, Healthy Measures Wellness Clinic, Greenwood, IN 46143 | 2014-11-10 |
| 1265831366 | Katie D'agosto | Counselor | 3000 S State Road 135 Ste 230, Greenwood, IN 46143 | 2014-08-14 |
| Find all providers in zip 46143 | ||||
| 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 |
|---|---|---|---|---|
| 1598205262 | Vignesh Kannan | Internal Medicine | Greenwood Leflore Hospital, 1401 River Rd, Greenwood, MS 38930 | 2017-03-01 |
| 1891176848 | Hugh Douglas Muse Jr. | Internal Medicine | 1401 River Rd Rm 442, Greenwood, MS 38930-4030 | 2015-06-16 |
| 1497917405 | Jeffrey Grande Albores | Internal Medicine | 105 Vinecrest Ct # 1000, Greenwood, SC 29646-8031 | 2008-06-30 |
| 1851569917 | Joseph W Logan Md Pa | Internal Medicine | 214 Cowhead Creek Road, Greenwood, SC 29646 | 2008-02-12 |
| 1003025511 | Melissa G Collier | Internal Medicine | 65 Airport Pkwy, Ste 114, Greenwood, IN 46143-1439 | 2007-05-21 |
| 1538283718 | John Walter Hendrix IIi | Internal Medicine | 408 West Alexander Avenue, Greenwood, SC 29646-4031 | 2007-03-16 |
| 1730270786 | Harold J Wheeler | Internal Medicine | 517 Highway 82 W, Greenwood, MS 38930-5030 | 2006-09-27 |
| 1013960590 | Cary Zietlow | Internal Medicine | 45 N Madison Ave, Greenwood, IN 46142-3526 | 2006-05-18 |
| 1821071267 | Michael T Boler | Internal Medicine | 201 Walthall St, Greenwood, MS 38930-4428 | 2005-11-21 |
| 1912989815 | Mohammed A Majid | Internal Medicine | 3089 W Fairview Rd, Greenwood, IN 46142-8504 | 2005-11-16 |
| Find all providers in GREENWOOD | ||||
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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.