SAINT ANTHONY MEDICAL CENTER (NPI# 1679526628) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1679526628 |
| Entity Type | Organization |
| Organization Name | SAINT ANTHONY MEDICAL CENTER |
| Other Organization Name | OSFMG - SOUTH RIDGE IMMEDIATE CARE |
| Practice Address |
4423 Manchester Dr Rockford IL 61109-1655 |
| Mailing Address |
Po Box 1712 Peoria IL 61656-1712 |
| Practice Telephone | 8005896070 |
| Practice Fax Number | 3096835969 |
| Enumeration Date | 2006-05-19 |
| Last Update Date | 2007-08-17 |
| Authorized Official Name | DR. GERALD J. MCSHANE (MEDICAL DIRECTOR) |
| Authorized Official Telephone | 3096557193 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | Y |
| Parent Organization Name | OSF HEALTHCARE SYSTEM |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363A00000X | Physician Assistant | Physician Assistants & Advanced Practice Nursing Providers | ||
| N | 363L00000X | Nurse Practitioner | Physician Assistants & Advanced Practice Nursing Providers | ||
| Y | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | BLUE CROSS | 10123444 | 01 |
| Other Name | Type Code |
|---|---|
| OSFMG - South Ridge Immediate Care | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023051992 | Saint Anthony Medical Center | Home Health | 5501 E State St, Rockford, IL 61108-2338 | 2006-06-14 |
| 1669428702 | Saint Anthony Medical Center | Internal Medicine | 5713 Strathmoor Dr, Rockford, IL 61107-7093 | 2006-05-26 |
| 1952356040 | Saint Anthony Medical Center | Physician Assistant | 6830 Villagreen Vw, Rockford, IL 61107-5639 | 2006-05-24 |
| 1003869967 | Saint Anthony Medical Center | Pediatrics | 556 E Grant Hwy, Marengo, IL 60152-3346 | 2006-05-19 |
| 1164475059 | Saint Anthony Medical Center | Nurse Practitioner | 9721 N Alpine Rd, Machesney Park, IL 61115-1664 | 2006-05-19 |
| 1235182288 | Saint Anthony Medical Center | Family Medicine | 143 Kishwaukee St, Belvidere, IL 61008-3507 | 2006-05-19 |
| 1225378722 | Saint Anthony Medical Center | Rehabilitation Unit | 5510 E State St, Rockford, IL 61108-2381 | 2013-02-20 |
| 1871860056 | Saint Anthony Medical Center | Neurological Surgery | 535 Roxbury Rd, Rockford, IL 61107-5076 | 2011-11-16 |
| 1265688766 | Saint Anthony Medical Center | Internal Medicine | 9951 Rock Cut Crossing, Loves Park, IL 61111 | 2008-08-15 |
| 1730335266 | Saint Anthony Medical Center | Internal Medicine | 9951 Rock Cut Crossing, Loves Park, IL 61111 | 2008-08-15 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | SAINT ANTHONY MEDICAL CENTER | 6368 Hollywood Blvd, Los Angeles, CA 90028-6320 |
| Street Address |
4423 MANCHESTER DR |
| City | ROCKFORD |
| State | IL |
| Zip Code | 61109-1655 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710965439 | Gary Michael Briden | Family Medicine | 4423 Manchester Dr, Rockford, IL 61109-1655 | 2006-01-03 |
| 1851324289 | Reginald Dinan Quart | Family Medicine | 4423 Manchester Dr, Rockford, IL 61109-1655 | 2006-07-09 |
| 1053357624 | Judith Ann Giolitto | Family Medicine | 4423 Manchester Dr, Rockford, IL 61109-1655 | 2006-06-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487164398 | Linda A Morel | Speech-Language Pathologist | 6129 Valley Knoll Drive, Rockford, IL 61109 | 2017-10-05 |
| 1841720315 | Activate Healthcare - Local 23 Clinic | Clinic/Center | 3413 Colony Bay, Rockford, IL 61109 | 2017-06-15 |
| 1255430062 | Suzanne E. Wang | Nurse Practitioner | 4940 East State Street, Rockford Veterans Administration Out Patient Clinic, Rockford, IL 61109 | 2006-09-21 |
| 1073597498 | Peter Joseph Gunther | Optometrist | 2995 Eastrock Dr, Rockford, IL 61109 | 2005-11-30 |
| 1104482769 | Catherine L Hill | Nurse's Aide | 2831 Bildahl St, Rockford, IL 61109-1136 | 2019-05-18 |
| 1962671701 | Rosecrance, Inc. | Substance Abuse Rehabilitation Facility | 3522 Green Dale Dr, Rockford, IL 61109-1575 | 2008-02-26 |
| 1326174665 | Lloyd Hearing Aid Corp | Hearing Instrument Specialist | 4435 Manchester Dr, Rockford, IL 61109-1655 | 2007-02-23 |
| 1386092625 | Andrew Palmquist | Hearing Instrument Specialist | 4435 Manchester Dr, Rockford, IL 61109-1655 | 2016-05-26 |
| 1396200929 | Ernesto Marin | Hearing Instrument Specialist | 4435 Manchester Dr, Rockford, IL 61109-1680 | 2019-02-07 |
| 1134127871 | Richard A Miller | Ophthalmology | 2995 Eastrock Dr, Rockford, IL 61109-1737 | 2005-07-07 |
| Find all providers in zip 61109 | ||||
| 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 |
|---|---|---|---|---|
| 1851910350 | Charity L Soles | Family Medicine | 4134 Ashwinton Way, Rockford, IL 61109-3273 | 2020-04-14 |
| 1306250543 | Camille Ryan | Family Medicine | 6050 Northland Dr Ne Ste 200, Rockford, MI 49341-9257 | 2014-06-16 |
| 1396991485 | Novella Ann Schafer | Family Medicine | 3719 Regal Ridge Circle, Rockford, IL 61114-6037 | 2008-08-08 |
| 1417139130 | Derek Lanier | Family Medicine | 8450 Brower Lake Rd Ne, Apt/suite, Rockford, MI 49341-9346 | 2007-12-04 |
| 1144414921 | Moses Godofredo Tomacruz | Family Medicine | 1502 Parkview Ave, Rockford, IL 61107-1821 | 2007-09-05 |
| 1508077165 | Robert Dejonge Do PC | Family Medicine | 350 Northland Dr Ne, Rockford, MI 49341-1401 | 2007-05-25 |
| 1902018641 | Julie Stark | Family Medicine | 3475 So Alpine Rd, Physicians Immediate Care, Rockford, IL 61109-2604 | 2007-05-04 |
| 1205976024 | Mohammed Khaleeluddin | Family Medicine | 1729 Oak Park Drive, Rockford, IL 61107-5510 | 2007-02-08 |
| 1134273238 | Swedishamerican Hosptial | Family Medicine | 3906 N Main St, Suite A, Rockford, IL 61103-1679 | 2007-01-23 |
| 1194897223 | Niccole Ranz | Family Medicine | 2222 E State St, Suite 209, Rockford, IL 61104-1573 | 2006-11-14 |
| Find all providers in ROCKFORD | ||||
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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.