PASSAVANT MEMORIAL AREA HOSPITAL ASSOCIATION (NPI# 1760994040) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1760994040 |
| Entity Type | Organization |
| Organization Name | PASSAVANT MEMORIAL AREA HOSPITAL ASSOCIATION |
| Other Organization Name | PASSAVANT PROFESSIONAL SERVICES |
| 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 | 2017-10-26 |
| Last Update Date | 2018-04-09 |
| Authorized Official Name | ROBERT L SILTMAN (DIRECTOR, PATIENT FINCNAIAL SERVICE) |
| Authorized Official Telephone | 2174795652 |
| Is Organization Subpart | Y |
| Parent Organization Name | PASSAVANT MEMORIAL AREA HOSPITAL ASSOCIATION |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians | ||
| N | 363L00000X | Nurse Practitioner | Physician Assistants & Advanced Practice Nursing Providers | ||
| Y | 207R00000X | Internal Medicine | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Passavant Professional Services | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 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 |
| 1689780520 | Passavant Memorial Area Hospital Association | Dietitian, Registered | 1600 W Walnut St, Jacksonville, IL 62650-1136 | 2006-08-22 |
| 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 |
| 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 |
| 1154867539 | Sravanthi Pallapothu | Physical Therapist | 1600 W Walnut St, Jacksonville, IL 62650-1136 | 2017-01-10 |
| 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 | 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 |
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.