CRUSADER CENTRAL CLINIC ASSOCIATION (NPI# 1730166323) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1730166323 |
| Entity Type | Organization |
| Organization Name | CRUSADER CENTRAL CLINIC ASSOCIATION |
| Other Organization Name | CRUSADER CLINIC |
| Practice Address |
1200 West State Street Rockford IL 61102-2112 |
| Practice Telephone | 8154901600 |
| Practice Fax Number | 8154901625 |
| Enumeration Date | 2005-12-27 |
| Last Update Date | 2007-07-08 |
| Authorized Official Name | MR. GORDON G EGGERS JR. (PRESIDENT CEO) |
| Authorized Official Telephone | 8154901604 |
| Authorized Official Credential | PA C |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| X | 122300000X | Dentist | Dental Providers | ||
| X | 152W00000X | Optometrist | Eye and Vision Services Providers | ||
| X | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians | ||
| X | 207R00000X | Internal Medicine | Allopathic & Osteopathic Physicians | ||
| X | 207RE0101X |
Internal Medicine Specialization: Endocrinology, Diabetes & Metabolism |
Allopathic & Osteopathic Physicians | ||
| X | 207V00000X | Obstetrics & Gynecology | Allopathic & Osteopathic Physicians | ||
| X | 208000000X | Pediatrics | Allopathic & Osteopathic Physicians | ||
| X | 213E00000X | Podiatrist | Podiatric Medicine & Surgery Service Providers |
| Other Name | Type Code |
|---|---|
| Crusader Clinic | Other Name - Individual/Organization |
| Street Address |
1200 WEST STATE STREET |
| City | ROCKFORD |
| State | IL |
| Zip Code | 61102-2112 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750675872 | Heather Nicole Sharp | Nurse Practitioner | 1200 West State Street, Rockford, IL 61102-2112 | 2011-06-06 |
| 1407309941 | Amanda Macke | Nurse Practitioner | 1200 West State Street, Rockford, IL 61102-2112 | 2016-08-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205115383 | Renee Lynn Keeney | Advanced Practice Midwife | 1200 W. State Street, Crusader Community Health, Rockford, IL 61102 | 2011-08-08 |
| 1689895906 | Linda Lou O'reilly | Local Education Agency (LEA) | 1515 S. Meridian Road, Rockford, IL 61102 | 2007-05-02 |
| 1801012992 | Jennifer Anne Boyd | Developmental Therapist | Nia 1515 S. Meridian Rd., Rockford, IL 61102 | 2007-04-17 |
| 1447751623 | Cynthia Uwase | Dentist | 1200 W State St, Rockford, IL 61102 | 2018-02-23 |
| 1033591847 | Jithinraj Edakkanambeth Varayil | Family Medicine | 1200 W State St, Rockford, IL 61102 | 2015-06-29 |
| 1194106849 | Naomi Thompson | Family Medicine | 1200 W State St, Rockford, IL 61102 | 2015-06-17 |
| 1811377617 | Serene Antoinette Bethune | Family Medicine | 1200 W State St, Rockford, IL 61102 | 2015-06-05 |
| 1013188408 | Gary Patrick Fernando | Pediatrics | 1200 W State St, Rockford, IL 61102 | 2008-03-13 |
| 1265602130 | Martin A Ganan | Pharmacist | 1200 W State St, Pharmacy, Rockford, IL 61102 | 2008-03-07 |
| 1609173434 | Kellie J Gibbons | Registered Nurse | 650 W State Street, Winnebago County Jail Medical Unit, Rockford, IL 61102-0000 | 2011-02-14 |
| Find all providers in zip 61102 | ||||
| Taxonomy Code | 122300000X |
| Grouping | Dental Providers |
| Classification | Dentist |
| A dentist is a person qualified by a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), licensed by the state to practice dentistry, and practicing within the scope of that license. There is no difference between the two degrees: dentists who have a DMD or DDS have the same education. Universities have the prerogative to determine what degree is awarded. Both degrees use the same curriculum requirements set by the American Dental Association's Commission on Dental Accreditation. Generally, three or more years of undergraduate education plus four years of dental school is required to graduate and become a general dentist. State licensing boards accept either degree as equivalent, and both degrees allow licensed individuals to practice the same scope of general dentistry. Additional post-graduate training is required to become a dental specialist. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700495074 | Tiffany Kimmel | Dentist | 6085 9 Mile Rd Ne, Rockford, MI 49341-7747 | 2020-07-23 |
| 1174016893 | Above & Beyond Denistry, LLC | Dentist | 364 Financial Ct Ste A, Rockford, IL 61107-6668 | 2018-06-07 |
| 1396255097 | Edwin Gonzalez Montoya | Dentist | 6585 E State St, Rockford, IL 61108-2542 | 2017-10-07 |
| 1124557228 | Alex Moore | Dentist | 6050 Brynwood Dr Ste 205, Rockford, IL 61114-6579 | 2017-06-12 |
| 1245686096 | Adriana Carolina Padron | Dentist | 275 Bienterra Trl Apt 4, Rockford, IL 61107-5882 | 2016-05-11 |
| 1275946113 | Jeffrey Heinz | Dentist | 158 Marcell Dr Ne Ste A, Rockford, MI 49341-1393 | 2014-06-09 |
| 1275872046 | Eugene Louis Bonofiglo | Dentist | 4655- 14 Mile Rd Ne, Rockford, MI 49341 | 2013-02-13 |
| 1326390113 | Apex-northwestern Dental Group LLP | Dentist | 364 Financial Ct, Suite A, Rockford, IL 61107-6668 | 2012-10-04 |
| 1285951004 | Bogdan Robert Busan | Dentist | 4035 Morsay Dr Ste 1, Rockford, IL 61107-4875 | 2010-05-03 |
| 1689800021 | Scott Strickland Dds Pllc | Dentist | 380 E. Division St., Rockford, MI 49341 | 2009-05-29 |
| 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.