PASSAVANT MEMORIAL AREA HOSPITAL ASSOCIATION (NPI# 1689780520) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1689780520 |
| Entity Type | Organization |
| Organization Name | PASSAVANT MEMORIAL AREA HOSPITAL ASSOCIATION |
| Other Organization Name | PASSAVANT AREA HOSPITAL |
| Practice Address |
1600 W Walnut St Jacksonville IL 62650-1136 |
| Practice Telephone | 2172459541 |
| Practice Fax Number | 2174798781 |
| Mailing Telephone | 2172459541 |
| Mailing Fax Number | 2174798781 |
| Enumeration Date | 2006-08-22 |
| Last Update Date | 2017-02-20 |
| Authorized Official Name | MR. HARRY M SCHMIDT (PRESIDENT AND CEO) |
| Authorized Official Telephone | 2172459541 |
| Is Organization Subpart | Y |
| Parent Organization Name | MEMORIAL HEALTH SYSTEM |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 133V00000X | Dietitian, Registered | ========= | IL | Dietary & Nutritional Service Providers |
| N | 208600000X | Surgery | ========= | IL | Allopathic & Osteopathic Physicians |
| N | 363L00000X | Nurse Practitioner | ========= | IL | Physician Assistants & Advanced Practice Nursing Providers |
| N | 367500000X | Nurse Anesthetist, Certified Registered | ========= | IL | Physician Assistants & Advanced Practice Nursing Providers |
| N | 207RH0003X |
Internal Medicine Specialization: Hematology & Oncology |
Allopathic & Osteopathic Physicians | ||
| Y | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians | ||
| N | 1041C0700X |
Social Worker Specialization: Clinical |
Behavioral Health & Social Service Providers | ||
| N | 225100000X | Physical Therapist | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Other Name | Type Code |
|---|---|
| Passavant Area Hospital | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760994040 | Passavant Memorial Area Hospital Association | Family Medicine | 1600 W Walnut St, Jacksonville, IL 62650-1136 | 2017-10-26 |
| 1366813404 | Passavant Memorial Area Hospital Association | Psychiatric Unit | 1600 W Walnut St, Jacksonville, IL 62650-1136 | 2015-10-15 |
| 1558530956 | Passavant Memorial Area Hospital Association | General Acute Care Hospital | 1600 W Walnut St, Jacksonville, IL 62650-1136 | 2008-02-29 |
| 1629115050 | Passavant Memorial Area Hospital Association | Skilled Nursing Facility | 1600 W Walnut St, Jacksonville, IL 62650 | 2007-02-01 |
| 1497861330 | Passavant Memorial Area Hospital Association | General Acute Care Hospital | 1600 W Walnut St, Jacksonville, IL 62650-1136 | 2006-08-22 |
| 1174580831 | Passavant Memorial Area Hospital Association | General Acute Care Hospital | 1600 W Walnut St, Jacksonville, IL 62650 | 2006-04-27 |
| Street Address |
1600 W WALNUT ST |
| City | JACKSONVILLE |
| State | IL |
| Zip Code | 62650-1136 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609873249 | Charles Milton Sheaff | Surgery | 1600 W Walnut St, East Wing 2nd Floor, Jacksonville, IL 62650-1136 | 2005-06-28 |
| 1528690799 | Holly Diane Pennell | Nurse Practitioner | 1600 W Walnut St, Jacksonville, IL 62650-1136 | 2020-02-06 |
| 1669004081 | Elizabeth Ann Johnson | Nurse Practitioner | 1600 W Walnut St, Jacksonville, IL 62650-1136 | 2020-02-05 |
| 1164053526 | Kayla Christine Vickers | Physical Therapist | 1600 W Walnut St, Jacksonville, IL 62650-1136 | 2020-02-03 |
| 1366912040 | Kelsi Lynn Dobson | Social Worker | 1600 W Walnut St, Jacksonville, IL 62650-1136 | 2018-11-26 |
| 1114402518 | Michelle Lee Geiss | Nurse Practitioner | 1600 W Walnut St, Jacksonville, IL 62650-1136 | 2018-10-02 |
| 1134606858 | Matthew Pulley | Nurse Practitioner | 1600 W Walnut St, Jacksonville, IL 62650-1136 | 2018-07-25 |
| 1760994040 | Passavant Memorial Area Hospital Association | Family Medicine | 1600 W Walnut St, Jacksonville, IL 62650-1136 | 2017-10-26 |
| 1871002238 | Courtney Howell | Social Worker | 1600 W Walnut St, Jacksonville, IL 62650-1136 | 2017-09-28 |
| 1831639194 | Carrie Elizabeth Janus | Nurse Practitioner | 1600 W Walnut St, The Center for Psychiatric Health, Jacksonville, IL 62650-1136 | 2017-03-06 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134768708 | Stephanie Lee Mabus | Occupational Therapy Assistant | 873 Gorve St, Jacksonville, IL 62650 | 2019-12-31 |
| 1285281071 | Sharshon Pharmacy Inc | Pharmacy | 154 W Morton Ave, Jacksonville, IL 62650 | 2019-08-26 |
| 1992275499 | Brittany Ruth Helmich | Counselor | 340 W. State St., Jacksonville, IL 62650 | 2018-11-28 |
| 1811391782 | Rodney E. Overstreet | Hearing Instrument Specialist | 1521 W. Walnut, Jacksonville, IL 62650 | 2014-10-21 |
| 1407979818 | Jan Ala | Speech-Language Pathologist | 1111 W Morton, Speechworks, Jacksonville, IL 62650 | 2007-04-09 |
| 1083787592 | Eldon G Barrowes Dds & Assoc PC | Dentist | 1515 West Walnut, Bldg #3, Jacksonville, IL 62650 | 2006-11-15 |
| 1194895979 | Joseph J Kozma | Internal Medicine | 1440 West Walnut, Jacksonville, IL 62650 | 2006-11-08 |
| 1740350529 | Susan Weller | Dentist | 1614 West Lafayette Avenue, Jackson, IL 62650 | 2006-11-08 |
| 1659467793 | Shawn M Fry | Family Medicine | 610 N. Westgate, Jacksonville, IL 62650 | 2006-10-05 |
| 1518050061 | Ward Richard Dunseth II | Nurse Anesthetist, Certified Registered | 1400 W Walnut, Jacksonville, IL 62650 | 2006-10-02 |
| Find all providers in zip 62650 | ||||
| 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 |
|---|---|---|---|---|
| 1528676186 | Sarah Colleen Tapscott | Family Medicine | 1908 Mill Creek Rd, Jacksonville, FL 32211-5052 | 2020-07-20 |
| 1790303170 | Samantha L Scott | Family Medicine | 516 Pierce Ln, Jacksonville, TX 75766-4546 | 2020-07-11 |
| 1689298689 | Meridian Spine and Joint, Inc | Family Medicine | 9770 Old Baymeadows Rd Ste 139, Jacksonville, FL 32256-7986 | 2020-06-04 |
| 1154942563 | Families First Medical Group | Family Medicine | 12086 Fort Caroline Rd Ste 103, Jacksonville, FL 32225-2688 | 2020-04-27 |
| 1598396392 | Pareto Population Health Management Practice Pllc | Family Medicine | 1697 Kings Rd Ste 1, Jacksonville, FL 32209-6169 | 2020-01-30 |
| 1942862206 | Cindy S Wright Do Pllc | Family Medicine | 12627 San Jose Blvd Ste 902, Jacksonville, FL 32223-8645 | 2019-07-07 |
| 1942868377 | Pain Spine & Wellness LLC | Family Medicine | 9770 Old Baymeadows Rd Ste 141, Jacksonville, FL 32256-7986 | 2019-05-31 |
| 1669035705 | Kathy Jo Daniels | Family Medicine | 10457 Wellington Springs Way, Jacksonville, FL 32221-1175 | 2019-04-15 |
| 1821579103 | Tiffany N Major | Family Medicine | 5194 Johnson Creek Dr, Jacksonville, FL 32218-9308 | 2018-08-24 |
| 1568987360 | Main Street Health LLC | Family Medicine | 2 Shircliff Way Ste 620, Jacksonville, FL 32204-4762 | 2017-08-14 |
| Find all providers in JACKSONVILLE | ||||
| City | JACKSONVILLE |
| Zip Code | 62650 |
Please comment or provide details below to improve the information on PASSAVANT MEMORIAL AREA HOSPITAL ASSOCIATION.
| 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.