PASSAVANT PHYSICIAN ASSOCIATION (NPI# 1720370778) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1720370778 |
| Entity Type | Organization |
| Organization Name | PASSAVANT PHYSICIAN ASSOCIATION |
| Other Organization Name | PASSAVANT INTERNAL MEDICINE RURAL HEALTH CLINIC |
| Practice Address |
559 N Westgate Ave Jacksonville IL 62650-1156 |
| Mailing Address |
1600 W Walnut St Jacksonville IL 62650-1136 |
| Practice Telephone | 2172435474 |
| Mailing Telephone | 2172459541 |
| Enumeration Date | 2011-05-10 |
| Last Update Date | 2011-07-06 |
| Authorized Official Name | MR. STEPHEN G LEE (MANAGER) |
| Authorized Official Telephone | 2174795890 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207R00000X | Internal Medicine | 036056832 | IL | Allopathic & Osteopathic Physicians |
| N | 363LA2200X |
Nurse Practitioner Specialization: Adult Health |
209004842 | IL | Physician Assistants & Advanced Practice Nursing Providers |
| Y | 207R00000X | Internal Medicine | 036091905 | IL | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Passavant Internal Medicine Rural Health Clinic | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205387958 | Passavant Physician Association | Obstetrics & Gynecology | 1600 W Walnut St, Jacksonville, IL 62650-1136 | 2016-10-18 |
| 1972054609 | Passavant Physician Association | Family Medicine | 559 N Westgate Ave, Jacksonville, IL 62650-1156 | 2016-10-18 |
| 1922410836 | Passavant Physician Association | Clinic/Center | 557 N Westgate Ave, Jacksonville, IL 62650-1156 | 2014-05-27 |
| 1841578507 | Passavant Physician Association | Nurse Practitioner | 1600 W Walnut St, Jacksonville, IL 62650-1136 | 2011-07-29 |
| 1962689307 | Passavant Physician Association | Family Medicine | 1600 W Walnut St, Jacksonville, IL 62650-1136 | 2008-01-29 |
| Street Address |
559 N WESTGATE AVE |
| City | JACKSONVILLE |
| State | IL |
| Zip Code | 62650-1156 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356393300 | Babu Rao Eladasari | Internal Medicine | 559 N Westgate Ave, Jacksonville, IL 62650-1156 | 2006-05-17 |
| 1972054609 | Passavant Physician Association | Family Medicine | 559 N Westgate Ave, Jacksonville, IL 62650-1156 | 2016-10-18 |
| 1184077554 | Hilary L. Boyle | Audiologist | 559 N Westgate Ave, Jacksonville, IL 62650-1156 | 2016-07-20 |
| 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 | 207R00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. |
| 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 Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760004329 | Colin Craig Rowell | Internal Medicine | 4500 San Pablo Rd S Fl 32, Jacksonville, FL 32224-1865 | 2020-05-17 |
| 1457982977 | Ateeque Khan, Md P.a. | Internal Medicine | 3659 Eastbury Dr, Jacksonville, FL 32224-1659 | 2020-02-03 |
| 1013478221 | Naji Maaliki | Internal Medicine | 653-1 W 8th St Fl L184, Jacksonville, FL 32209-6511 | 2019-03-29 |
| 1770043259 | Fadi Kandah | Internal Medicine | 653-1 W 8th St # L15, Jacksonville, FL 32209-6511 | 2019-03-21 |
| 1346696002 | Alana Akers | Internal Medicine | 203 Nacogdoches St Ste 290, Jacksonville, TX 75766-2444 | 2016-05-11 |
| 1346602927 | Kevin Roy Green | Internal Medicine | 653-1 W 8th St # L18, Jacksonville, FL 32209-6511 | 2016-03-23 |
| 1093175770 | Alex Balmir | Internal Medicine | 655 W 8th St # Cc262, Jacksonville, FL 32209-6511 | 2016-02-24 |
| 1336529817 | Nader Daoud | Internal Medicine | 1 Shircliffway, Jacksonville, FL 32204 | 2015-06-01 |
| 1316338957 | Deep Patel | Internal Medicine | 5238 Norwood Ave Ste 16, Jacksonville, FL 32208-5005 | 2015-02-17 |
| 1063801934 | Avecina Medical | Internal Medicine | 9580 Applecross Rd, 106, Jacksonville, FL 32222-5845 | 2015-01-15 |
| Find all providers in JACKSONVILLE | ||||
| City | JACKSONVILLE |
| Zip Code | 62650 |
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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.