PASSAVANT PHYSICIAN ASSOCIATION


Address: 1600 W Walnut St, Jacksonville, IL 62650-1136
Phone: 2172459541

PASSAVANT PHYSICIAN ASSOCIATION (NPI# 1841578507) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1841578507
Entity Type Organization
Organization Name PASSAVANT PHYSICIAN ASSOCIATION
Other Organization Name WOUND CLINIC RHC
Practice Address 1600 W Walnut St
Jacksonville
IL 62650-1136
Practice Telephone 2172459541
Mailing Telephone 2172459541
Enumeration Date 2011-07-29
Last Update Date 2011-07-29
Authorized Official Name MR. STEPHEN G LEE (PLAN ADMINISTRATOR)
Authorized Official Telephone 2174795890
Is Organization Subpart N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
N 363LA2200X Nurse Practitioner
Specialization: Adult Health
209007563 IL Physician Assistants & Advanced Practice Nursing Providers
Y 207Q00000X Family Medicine 036098965 IL Allopathic & Osteopathic Physicians

Other Provider/Organization Names

Other Name Type Code
WOUND CLINIC RHC Doing Business As Name - Organization

Other Provider IDs and Locations

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
1720370778 Passavant Physician Association Internal Medicine 559 N Westgate Ave, Jacksonville, IL 62650-1156 2011-05-10
1962689307 Passavant Physician Association Family Medicine 1600 W Walnut St, Jacksonville, IL 62650-1136 2008-01-29

Office Location

Street Address 1600 W WALNUT ST
City JACKSONVILLE
State IL
Zip Code 62650-1136

Providers in the same location

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
1760994040 Passavant Memorial Area Hospital Association Family Medicine 1600 W Walnut St, Jacksonville, IL 62650-1136 2017-10-26
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
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Providers in the same zip code

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
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Taxonomy Information

Taxonomy Code 207Q00000X
Grouping Allopathic & Osteopathic Physicians
Classification Family Medicine

Taxonomy Definition

Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition]
- Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences.
- Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, 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 Physicians or the American Board of Family Medicine.

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1528676186 Sarah Colleen Tapscott Family Medicine 1908 Mill Creek Rd, Jacksonville, FL 32211-5052 2020-07-20
1790303170 Samantha L Scott Family Medicine 516 Pierce Ln, Jacksonville, TX 75766-4546 2020-07-11
1689298689 Meridian Spine and Joint, Inc Family Medicine 9770 Old Baymeadows Rd Ste 139, Jacksonville, FL 32256-7986 2020-06-04
1154942563 Families First Medical Group Family Medicine 12086 Fort Caroline Rd Ste 103, Jacksonville, FL 32225-2688 2020-04-27
1598396392 Pareto Population Health Management Practice Pllc Family Medicine 1697 Kings Rd Ste 1, Jacksonville, FL 32209-6169 2020-01-30
1942862206 Cindy S Wright Do Pllc Family Medicine 12627 San Jose Blvd Ste 902, Jacksonville, FL 32223-8645 2019-07-07
1942868377 Pain Spine & Wellness LLC Family Medicine 9770 Old Baymeadows Rd Ste 141, Jacksonville, FL 32256-7986 2019-05-31
1669035705 Kathy Jo Daniels Family Medicine 10457 Wellington Springs Way, Jacksonville, FL 32221-1175 2019-04-15
1821579103 Tiffany N Major Family Medicine 5194 Johnson Creek Dr, Jacksonville, FL 32218-9308 2018-08-24
1568987360 Main Street Health LLC Family Medicine 2 Shircliff Way Ste 620, Jacksonville, FL 32204-4762 2017-08-14
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Competitor

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City JACKSONVILLE
Zip Code 62650

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Dataset Information

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.

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