AJA LYSTILA (NPI# 1215159744) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1215159744 |
| Entity Type | Individual |
| Full Name | AJA LYSTILA |
| Credential | MD |
| Practice Address |
2512 Hurst Dr. Family Medicine Mattoon IL 61938-9388 |
| Mailing Address |
611 W. Park St. Bwpc Urbana IL 61801-2500 |
| Practice Telephone | 2172585900 |
| Practice Fax Number | 2172585904 |
| Mailing Telephone | 2173836792 |
| Mailing Fax Number | 2172585904 |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2015-03-09 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207P00000X | Emergency Medicine | 036119163 | IL | Allopathic & Osteopathic Physicians |
| Y | 207Q00000X | Family Medicine | 036119163 | IL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | 036119163 | 05 |
| Street Address |
2512 HURST DR. FAMILY MEDICINE |
| City | MATTOON |
| State | IL |
| Zip Code | 61938-9388 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609863620 | Hong Holly Zhang | Physician Assistant | 2512 Hurst Dr., Ste 120, Mattoon, IL 61938-9388 | 2005-10-04 |
| 1184856825 | Karri L. Brown | Nurse Practitioner | 2512 Hurst Dr., Mattoon, IL 61938-2500 | 2009-08-13 |
| 1407006828 | Kelly L Holt | Registered Nurse | 2512 Hurst Dr., Mattoon, IL 61938-9388 | 2008-09-22 |
| 1215198189 | Kristine Ross Carpenter | Family Medicine | 2512 Hurst Dr., Mattoon, IL 61938 | 2008-06-23 |
| 1033222625 | David R Knox | Pediatrics | 2512 Hurst Dr., Mattoon, IL 61938-2500 | 2006-08-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043831134 | St Anthony's Memorial Hospital of The Hospital Sisters of The Third Or | Clinic/Center | 101 Coles Centre Pkwy, Ste 101, Mattoon, IL 61938 | 2020-04-30 |
| 1215436449 | Sarah Bush Lincoln Health Center | Durable Medical Equipment & Medical Supplies | 300 Coles Centre Pkwy, Mattoon, IL 61938 | 2018-02-02 |
| 1841707726 | Mattoon Chiropractic LLC | Chiropractor | 905 Remington Rd, Mattoon, IL 61938 | 2018-01-02 |
| 1164892758 | Dr. Charles L. Schnibben Ltd. | Dentist | 1502 Lakeland Blvd, Mattoon, IL 61938 | 2015-09-25 |
| 1982000139 | Judy A. Clark | Hearing Instrument Specialist | 1302 Charleston Avenue, Audibel Hearing Aids, Mattoon, IL 61938 | 2014-11-17 |
| 1023419884 | Christopher Steven Lillie | Physician Assistant | 200 Richmond Ave East, Family Medical Center, Mattoon, IL 61938 | 2014-09-11 |
| 1295055168 | Jennifer Harp | Mechanotherapist | 232 Richmond Ave East, Mattoon, IL 61938 | 2010-06-02 |
| 1447482682 | Gene Clark Hearing Aid Service | Hearing Aid Equipment | 208 Wabash, Mattoon, IL 61938 | 2009-08-21 |
| 1326229774 | Central Illinois Family Health Center | Nurse Practitioner | 10555 East County Rd 800 North, Mattoon, IL 61938 | 2007-11-14 |
| 1568656445 | Bernie Ranchero | Family Medicine | 1004 Health Center Dr Ste 210, Mattoon, IL 61938 | 2007-09-04 |
| Find all providers in zip 61938 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710392444 | Angela Azor | Family Medicine | 101 Coles Centre Dr, Mattoon, IL 61938-9314 | 2014-06-20 |
| 1447513148 | Amanda Rubush | Family Medicine | 2512 Hurrst Dr., Suite 130, Mattoon, IL 61938-9200 | 2012-06-19 |
| 1912174970 | Lucas L Catt | Family Medicine | 1005 Health Center Dr Ste 103, Mattoon, IL 61938-4693 | 2008-05-09 |
| 1568656445 | Bernie Ranchero | Family Medicine | 1004 Health Center Dr Ste 210, Mattoon, IL 61938 | 2007-09-04 |
| 1467570507 | Sarah Bush Lincoln Health Center | Family Medicine | 200 Professional Plz, Mattoon, IL 61938-9280 | 2007-03-27 |
| 1588782627 | Sarah Bush Lincoln Health Center | Family Medicine | 1005 Health Center Drive, Suite 103, Prairie Pavilion I, Mattoon, IL 61938-4693 | 2007-03-27 |
| 1528176880 | Matthew James Dorner | Family Medicine | 3555 E Cr 250n, Mattoon, IL 61938 | 2006-08-28 |
| 1255343026 | Dawn Miesner | Family Medicine | 2512 Hurst Dr, Ste 120, Mattoon, IL 61938 | 2006-08-12 |
| 1063952240 | Sarah Bush Lincoln Health Center | Family Medicine | 1004 Health Center Dr, Suite 210, Mattoon, IL 61938-9253 | 2017-03-07 |
| 1114381514 | Emily A Metzger | Family Medicine | 2512 Hurst Dr Ste 130, Mattoon, IL 61938-9200 | 2016-04-12 |
| Find all providers in MATTOON | ||||
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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.