MCLEAN COUNTY NEUROLOGY SC (NPI# 1760431712) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1760431712 |
| Entity Type | Organization |
| Organization Name | MCLEAN COUNTY NEUROLOGY SC |
| Practice Address |
2204 Eastland Dr Bloomington IL 61704-3566 |
| Practice Telephone | 3096629461 |
| Mailing Telephone | 3096629461 |
| Enumeration Date | 2006-05-08 |
| Last Update Date | 2008-06-05 |
| Authorized Official Name | DR. HERMAN JUSTUS DICK JR. (MANAGING PARTNER) |
| Authorized Official Telephone | 3096629461 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2084N0400X |
Psychiatry & Neurology Specialization: Neurology |
Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | MEDID | CF6543 | 01 |
| IL | BLUE CROSS BLUE SHIELD | 5715381 | 01 |
| Street Address |
2204 EASTLAND DR |
| City | BLOOMINGTON |
| State | IL |
| Zip Code | 61704-3566 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588859169 | Munib Said Mafazy | Nurse Practitioner | 2204 Eastland Dr, Bloomington, IL 61704-3566 | 2007-09-07 |
| 1386738375 | William Raino | Psychiatry & Neurology | 2204 Eastland Dr, Bloomington, IL 61704-3566 | 2006-10-03 |
| 1760588248 | Curtis J. Hayden | Specialist | 2204 Eastland Dr, Bloomington, IL 61704-3566 | 2006-09-15 |
| 1356447841 | Fang Li | Specialist | 2204 Eastland Dr, Bloomington, IL 61704-3566 | 2006-09-15 |
| 1891891370 | Herman Justis Dick Jr. | Specialist | 2204 Eastland Dr, Bloomington, IL 61704-3566 | 2006-09-15 |
| 1407965130 | Sleep Center of Central Illinois LLC | Clinic/Center | 2204 Eastland Dr, Suite 100, Bloomington, IL 61704-3567 | 2006-08-29 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518430859 | Visionpoint Eye Center LLC | Optometrist | 1107 Airport Road, Bloomington, IL 61704 | 2019-01-09 |
| 1922588235 | Geethu Sabu Makil | Speech-Language Pathologist | 1039 Blueheron Way, Apt#3, Bloomington, IL 61704 | 2018-08-16 |
| 1629596812 | Mental Wellness Center Inc | Counselor | 202 N Prospect Rd Ste 207, Bloomington, IL 61704 | 2017-09-07 |
| 1649798513 | Sarah Goodner | Psychologist | 1704 Royal Pointe Drive, Bloomington, IL 61704 | 2017-08-31 |
| 1346760253 | Elizabeth Devlin | Nurse Practitioner | 25 Long Cove Ct, Bloomington, IL 61704 | 2017-06-21 |
| 1396107918 | Darla Schwertfeger | Specialist/Technologist, Other | 2104 Hedgewood Dr, Bloomington, IL 61704 | 2016-03-23 |
| 1740662949 | Oncology Hematology Associates of Central Illinois | Pharmacy | 3105 Magory Drive, Bloomington, IL 61704 | 2015-06-24 |
| 1821478967 | Kelly R Andrews | Massage Therapist | 4101 Wicker Rd, Bloomington, IL 61704 | 2015-06-03 |
| 1235522582 | All Ways Caring Services, Inc. | In Home Supportive Care | 209 S Prospect Rd, Suite 3e, Bloomington, IL 61704 | 2015-03-11 |
| 1396093977 | Bhawna Gupta | Physical Therapist | 2200 East Washington Street, Bloomington, IL 61704 | 2012-08-29 |
| Find all providers in zip 61704 | ||||
| Taxonomy Code | 2084N0400X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Neurology |
| A Neurologist specializes in the diagnosis and treatment of diseases or impaired function of the brain, spinal cord, peripheral nerves, muscles, autonomic nervous system, and blood vessels that relate to these structures. |
| Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083848550 | David W Harvey | Psychiatry & Neurology | 321 S Landmark Ave, Bloomington, IN 47403-5001 | 2009-05-12 |
| 1568667772 | Edward W Pegg Md, LLC | Psychiatry & Neurology | 1505 Eastland Dr Ste 2400, Bloomington, IL 61701-7911 | 2007-06-18 |
| 1245248293 | Jameson Daniel Way | Psychiatry & Neurology | 2315 E 3rd St, Bloomington, IN 47401-5320 | 2006-08-04 |
| 1689150948 | Barbara Luann Weis | Psychiatry & Neurology | 1701 E College Ave, Bloomington, IL 61704-2101 | 2018-07-18 |
| 1770038069 | Supriya Kairamkonda | Psychiatry & Neurology | 583 S Clarizz Blvd, Bloomington, IN 47401-5515 | 2016-08-17 |
| 1336403237 | Derrick Alwyn Fox | Psychiatry & Neurology | 1701 E College Ave, Bloomington, IL 61704-2101 | 2012-06-26 |
| 1477875938 | Mehyar Mehrizi | Psychiatry & Neurology | 583 S Clarizz Blvd, Bloomington, IN 47401-5515 | 2010-02-24 |
| 1326233271 | Barry Jay Riskin | Psychiatry & Neurology | 2502 E Empire St, Bloomington, IL 61704-3738 | 2007-09-12 |
| 1194865642 | Neurology Specialists, PC | Psychiatry & Neurology | 813 W 2nd St, Bloomington, IN 47403-2212 | 2007-02-07 |
| 1043392160 | Edward W Pegg IIi | Psychiatry & Neurology | 1505 Eastland Dr, Suite 2400, Bloomington, IL 61701-3534 | 2006-10-19 |
| Find all providers in BLOOMINGTON | ||||
| City | BLOOMINGTON |
| Zip Code | 61704 |
Please comment or provide details below to improve the information on MCLEAN COUNTY NEUROLOGY SC.
| 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.