JON O HUMPHREY (NPI# 1699972893) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1699972893 |
| Entity Type | Individual |
| Full Name | JON O HUMPHREY |
| Credential | M.D. |
| Practice Address |
305 W Jackson St Suite 200 Carbondale IL 62901-1474 |
| Mailing Address |
701 N 1st St Po Box 19639 Springfield IL 62794-9639 |
| Practice Telephone | 6184533777 |
| Practice Fax Number | 6184531102 |
| Mailing Telephone | 2175457578 |
| Mailing Fax Number | 2175451884 |
| Enumeration Date | 2007-06-29 |
| Last Update Date | 2007-08-20 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207QS0010X |
Family Medicine Specialization: Sports Medicine |
IL | Allopathic & Osteopathic Physicians |
| Street Address |
305 W JACKSON ST SUITE 200 |
| City | CARBONDALE |
| State | IL |
| Zip Code | 62901-1474 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871596726 | John Ward Watson | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 305 W Jackson St, Suite 105, Carbondale, IL 62901-1474 | 2005-05-24 |
| 1780034926 | Ahmed Sharif | Family Medicine | 305 W Jackson St, Carbondale, IL 62901-1474 | 2016-06-19 |
| 1548619406 | Jordan Wood | Family Medicine | 305 W Jackson St, Carbondale, IL 62901-1474 | 2016-06-10 |
| 1225499825 | Ashley Nicole Freeman | Nurse Practitioner | 305 W Jackson St, Ste 103, Carbondale, IL 62901 | 2016-03-10 |
| 1548625460 | Kasia Schaefer | Physical Medicine & Rehabilitation | 305 W Jackson St, Carbondale, IL 62901-1474 | 2015-12-18 |
| 1770966137 | Pamela Renee Milano | Family Medicine | 305 W Jackson St, Ste 200, Carbondale, IL 62901-1474 | 2015-07-02 |
| 1215319140 | Gritz Pierre | Family Medicine | 305 W Jackson St, 200, Carbondale, IL 62901-1474 | 2015-06-27 |
| 1154702116 | Nabeel Mohammed Siddiqui | Family Medicine | 305 W Jackson St, Suite 200, Carbondale, IL 62901-1474 | 2015-06-16 |
| 1992196752 | New Horizons Medical Associates, LLC | Obstetrics & Gynecology | 305 W Jackson St, Suite 100, Carbondale, IL 62901-1474 | 2015-02-13 |
| 1255747002 | Fariha Rub | Family Medicine | 305 W Jackson St, Suite 200, Carbondale, IL 62901-1474 | 2014-07-01 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558961268 | Gerad Aaron Harsy | Pharmacist | Walmart Pharmcy, 1450 East Main St, Carbondale, IL 62901 | 2020-10-30 |
| 1437708674 | Board of Trustees of Southern Illinois University | Clinic/Center | 300 W Oak Street, Carbondale, IL 62901 | 2019-09-10 |
| 1306317383 | Rachael O Johnson | Nurse Practitioner | 404 S. Lewis Ln, Carbondale, IL 62901 | 2018-12-17 |
| 1740795194 | Megan Marie Zimmerman | Nurse Practitioner | 1100 W Diann Ln., Carbondale, IL 62901 | 2017-12-07 |
| 1295244242 | Amy Elizabeth Prudencio | Social Worker | 1301 E. Walnut Street, Carbondale, IL 62901 | 2017-09-21 |
| 1740708171 | Theresa Aleise Goodin | Speech-Language Pathologist | 1301 East Walnut Street, Carbondale, IL 62901 | 2017-09-06 |
| 1144762527 | Kathleen Chwalisz Rigney | Psychologist | 306 West Mill Street, Neurorestorative, Carbondale, IL 62901 | 2016-11-16 |
| 1285185173 | Shawnee Health Service and Development Corp | Social Worker | 404 S. Lewis Lane, Carbondale, IL 62901 | 2016-10-17 |
| 1437605094 | Arielle Greer | Nurse's Aide | 510 E. Russell St., A, Carbondale, IL 62901 | 2016-09-01 |
| 1518413863 | Complete Family Eyecare of Carbondale, PC | Optometrist | 1241 East Walnut Street, Carbondale, IL 62901 | 2016-08-28 |
| Find all providers in zip 62901 | ||||
| Taxonomy Code | 207QS0010X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Specialization | Sports Medicine |
| A family medicine physician that is trained to be responsible for continuous care in the field of sports medicine, not only for the enhancement of health and fitness, but also for the prevention of injury and illness. A sports medicine physician must have knowledge and experience in the promotion of wellness and the prevention of injury. Knowledge about special areas of medicine such as exercise physiology, biomechanics, nutrition, psychology, physical rehabilitation, epidemiology, physical evaluation, injuries (treatment and prevention and referral practice) and the role of exercise in promoting a healthy lifestyle are essential to the practice of sports medicine. The sports medicine physician requires special education to provide the knowledge to improve the health care of the individual engaged in physical exercise (sports) whether as an individual or in team participation. |
| 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 Family Medicine, 2007. http://www.theabfm.org/. American Osteopathic Board of Family Medicine, 2007. http://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 Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073927612 | Thomas Murphy | Family Medicine | 305 W Jackson St Ste 200, Carbondale, IL 62901-1474 | 2014-06-11 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164817334 | Shachi Pandya | Family Medicine | 18350 Kedzie Ave Ste 101, Homewood, IL 60430 | 2015-04-03 |
| 1821438185 | Marianne Hana | Family Medicine | 60 Orland Square Dr Ste 101, Orland Park, IL 60462 | 2013-07-01 |
| 1376894501 | Rush-copley Medical Group | Family Medicine | 2040 Ogden Ave., Suite 304, Aurora, IL 60504 | 2012-09-27 |
| 1144495961 | Karsten B Slater | Family Medicine | 1527 College Dr, Mount Carmel, IL 62863 | 2008-04-23 |
| 1104000561 | Competitive Edge Sports Medicine | Family Medicine | 14160 Jamestown Rd, Breese, IL 62230 | 2007-12-20 |
| 1477734150 | Sashil Singh Kapur | Family Medicine | 415 N Lasalle Street, Suite 100, Chicago, IL 60654 | 2007-11-21 |
| 1659562585 | Ketan R Mody | Family Medicine | 760 Pasquinelli Dr Ste 304, Westmont, IL 60559-1290 | 2007-08-06 |
| 1285841544 | Arthur Aragones | Family Medicine | 135 E Irving Park Rd, Streamwood, IL 60107-2950 | 2007-05-17 |
| 1003028150 | Jill Wirth-rissman | Family Medicine | 205 N Cummings Ln, Washington, IL 61571-2181 | 2007-05-03 |
| 1497838676 | Christopher Eric Cieurzo | Family Medicine | 510 Pow Mia St Bldg P40, Scott Afb, IL 62225-5020 | 2006-10-23 |
| Find all providers with the same taxonomy | ||||
| City | CARBONDALE |
| Zip Code | 62901 |
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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.