ST. MARYS HOSPITAL DECATUR OF THE HOSPITAL SISTERS OF THE THIRD ORDER (NPI# 1174702708) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1174702708 |
| Entity Type | Organization |
| Organization Name | ST. MARYS HOSPITAL DECATUR OF THE HOSPITAL SISTERS OF THE THIRD ORDER |
| Other Organization Name | THE SPORTS & PHYSICAL MEDICINE CLINIC @ ST. MARY'S |
| Practice Address |
1900 E Lake Shore Dr Suite 200 Decatur IL 62521-3824 |
| Practice Telephone | 2174641030 |
| Practice Fax Number | 2174641039 |
| Mailing Telephone | 2174641030 |
| Mailing Fax Number | 2174641039 |
| Enumeration Date | 2007-10-31 |
| Last Update Date | 2007-10-31 |
| Authorized Official Name | MR. DON A DAVIS (DIRECTOR, PHYSICIAN SERVICES) |
| Authorized Official Telephone | 2174642676 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | IL | Physician Assistants & Advanced Practice Nursing Providers |
| Other Name | Type Code |
|---|---|
| The Sports & Physical Medicine Clinic @ St. Mary's | Doing Business As Name - Organization |
| Street Address |
1900 E LAKE SHORE DR SUITE 200 |
| City | DECATUR |
| State | IL |
| Zip Code | 62521-3824 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992704332 | Samir A Patel | Pediatrics | 1900 E Lake Shore Dr, Suite 330, Decatur, IL 62521-3824 | 2005-07-19 |
| 1306238746 | Crystal Louise Zeigler | Specialist/Technologist | 1900 E Lake Shore Dr, Decatur, IL 62521-3824 | 2015-02-23 |
| 1881935435 | Deepthi Seekuri Manoj | Pediatrics | 1900 E Lake Shore Dr, Decatur, IL 62521-3824 | 2013-03-06 |
| 1811274889 | Sherrie Knutson | Specialist/Technologist | 1900 E Lake Shore Dr, Decatur, IL 62521-3824 | 2011-11-04 |
| 1639458623 | Tracy Pulliam | Social Worker | 1900 E Lake Shore Dr, Suite 201, Decatur, IL 62521-3824 | 2011-08-09 |
| 1316253578 | Linda S Pietrzak | Nurse Practitioner | 1900 E Lake Shore Dr, Suite 330, Decatur, IL 62521-3824 | 2010-08-26 |
| 1790961977 | Kare4kids Sc | Pediatrics | 1900 E Lake Shore Dr, Suite 330, Decatur, IL 62521-3824 | 2008-01-17 |
| 1861680704 | Zachary Lee Sowa | Physician Assistant | 1900 E Lake Shore Dr, Suite 200, Decatur, IL 62521-3846 | 2007-10-04 |
| 1407055353 | Amy L Kindred Johnson | Nurse Practitioner | 1900 E Lake Shore Dr, Suite 330, Decatur, IL 62521-3848 | 2007-07-12 |
| 1144437195 | David L Holtzscher | Specialist/Technologist | 1900 E Lake Shore Dr, Suite 150, Decatur, IL 62521-3824 | 2007-05-17 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053927988 | Caleb David Braasch | Pharmacist | 1818 South Airport Rd, Decatur, IL 62521 | 2020-09-16 |
| 1295390490 | Crossing Recovery Center | Substance Abuse Rehabilitation Facility | Crossing Recovery Center, 495 East Central Ave, Decatur, IL 62521 | 2019-05-03 |
| 1396300638 | Crossing Recovery Center | Substance Abuse Rehabilitation Facility | 495 E Central Ave, Decatur, IL 62521 | 2019-05-02 |
| 1679138911 | Crossing Recovery Center | Substance Abuse Rehabilitation Facility | 495 East Central Ave, Decatur, IL 62521 | 2019-05-02 |
| 1154848034 | Zack Shaw | Physical Therapist | 4855-57 East 36, Decatur, IL 62521 | 2017-08-23 |
| 1790032852 | Prashant Morolia | Family Medicine | 4775 E Maryland St, Decatur, IL 62521 | 2012-08-08 |
| 1003188913 | Evergreen Place Decatur, LLC | Assisted Living Facility | 4825 E Evergreen Court, Decatur, IL 62521 | 2012-02-08 |
| 1104133099 | Suzette Marie Shafer | Occupational Therapy Assistant | 1790 S. Fairview Ave., Decatur, IL 62521 | 2010-09-13 |
| 1467784090 | Community Health Improvement Center | Clinic/Center | 1221 East Condit Street, Decatur, IL 62521 | 2010-02-08 |
| 1982839056 | Kelly Clark Dds PC | Dentist | 3737 Us Rt 36 E, Decatur, IL 62521 | 2009-05-19 |
| Find all providers in zip 62521 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598374860 | Lauren Nolan | Physician Assistant | 500 Irvin Ct # 200, Decatur, GA 30030-1705 | 2020-07-23 |
| 1134749930 | Elissa Stanton | Physician Assistant | 1280 Sanden Ferry Dr, Decatur, GA 30033-3346 | 2020-04-21 |
| 1902457138 | April Lynette Williams | Physician Assistant | 3669 Riverchase Ter, Decatur, GA 30034-4876 | 2019-09-29 |
| 1194389353 | Katherine Serafen | Physician Assistant | 2701 N Decatur Road, Ground Floor Suite 520, Decatur, GA 30033 | 2019-04-23 |
| 1124531249 | Carolina Espina | Physician Assistant | 2665 N Decatur Rd Ste 630, Decatur, GA 30033-6147 | 2017-11-10 |
| 1447703731 | Jessica Lin Brewer | Physician Assistant | 2186 Clairmont Rd, Decatur, GA 30033-1937 | 2016-08-03 |
| 1174972459 | Peter Bell | Physician Assistant | 2946 Clifton Springs Rd, Decatur, GA 30034-3820 | 2016-06-08 |
| 1902299597 | Farida Ahmadi | Physician Assistant | 200 E Ponce De Leon Ave Ste 110, Decatur, GA 30030-3467 | 2015-03-06 |
| 1730431313 | Daniel Lau | Physician Assistant | 2801 N. Decatur Road Suite 200, Decatur, GA 30033 | 2012-10-08 |
| 1720344302 | Kanwal Kapadia Lalani | Physician Assistant | 2665 N Decatur Rd Ste 430, Decatur, GA 30033-6145 | 2012-04-08 |
| Find all providers in DECATUR | ||||
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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.