Dale W Blaise (NPI# 1770557472, PAC ID# 0941106660) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is FAMILY MEDICINE.
| Nation Provider ID (NPI) | 1770557472 |
| PAC ID by PECOS | 0941106660 |
| Professional Enrollment ID | I20070329000493 |
| Full Name | Dale W Blaise |
| Organization Legal Name | SOUTHERN ILLINOIS MEDICAL SERVICES, NFP |
| Address |
19 E Shawnee Dr Suite 2 Murphysboro IL 62966-7072 |
| Phone Number | 6186842172 |
| Gender | M |
| Credential | MD |
| Medical School | UNIVERSITY OF ILLINOIS AT CHICAGO HEALTH SCIENCE CENTER |
| Graduation Year | 1981 |
| Primary Specialty | FAMILY MEDICINE |
| Group Practice PAC ID | 3678677390 |
| Number of Group Practice Members | 325 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 140164 | MEMORIAL HOSPITAL OF CARBONDALE |
| 141334 | ST JOSEPH MEMORIAL HOSPITAL |
| 140011 | SOUTHERN ILLINOIS HOSPITAL SERVICES DBA HERRIN HOSPITAL |
| Address | Phone | Organization |
|---|---|---|
| 19 E Shawnee Dr, Suite 2, Murphysboro, IL 62966-7072 | 6186842172 | SOUTHERN ILLINOIS MEDICAL SERVICES, NFP |
| Organization Legal Name | SOUTHERN ILLINOIS MEDICAL SERVICES, NFP |
| Physicians | 338 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Ellie Marie Bentley | General Surgery | Southern Illinois Medical Services, Nfp | 220 S Park Ave, Suite 3, Herrin, IL 62948-3612 |
| Victor Cepeda | Infectious Disease | Southern Illinois Medical Services, Nfp | 3314 Patriot Ct, Herrin, IL 62948-3782 |
| Arsalan Salamat | General Surgery | Southern Illinois Medical Services, Nfp | 1237 E Main St, C1, Carbondale, IL 62901-3148 |
| Motaz R Wraikat | Undersea and Hyperbaric Medicine | Southern Illinois Medical Services, Nfp | 315 S 14th St, Suite 3, Herrin, IL 62948-3601 |
| Mohammed Lawan Gana Guba | Hospitalist | Southern Illinois Medical Services, Nfp | 201 S 14th St, Herrin, IL 62948-3631 |
| Kowsika Movva | Family Medicine | Southern Illinois Medical Services, Nfp | 207 W Jackson St, Suite 102, Carbondale, IL 62901-1408 |
| Hammad Shafqat | Hematology/oncology | Southern Illinois Medical Services, Nfp | 1400 Pin Oak Dr, Carterville, IL 62918-1600 |
| Whitney Celeste Mcguire | Nurse Practitioner | Southern Illinois Medical Services, Nfp | 405 Rushing Dr, Herrin, IL 62948-3730 |
| Jason Liang | Podiatry | Southern Illinois Medical Services, Nfp | 19 E Shawnee Dr, Suite 2, Murphysboro, IL 62966-7072 |
| Saad Ajmal | General Surgery | Southern Illinois Medical Services, Nfp | 317 S 14th St, Suite 1, Herrin, IL 62948-3673 |
| Street Address |
19 E SHAWNEE DR SUITE 2 |
| City | MURPHYSBORO |
| State | IL |
| Zip | 62966-7072 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Jason Liang | Podiatry | Southern Illinois Medical Services, Nfp | 19 E Shawnee Dr, Suite 2, Murphysboro, IL 62966-7072 |
| Kati Rush | Podiatry | Southern Illinois Medical Services, Nfp | 19 E Shawnee Dr, Suite 2, Murphysboro, IL 62966-7072 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Robert L Mills | Chiropractic | Health Centers of Southern Illinois Sc. | 1012 N 14th St, Murphysboro, IL 62966-1600 |
| Evan T Belfer | Family Medicine | 801 N 14th St, Murphysboro, IL 62966-1611 | |
| Thomas W Kupferer | Family Medicine | 628 N 14th St, Murphysboro, IL 62966-1807 | |
| Geoffrey A Spears | Optometry | 1008 Locust, Murphysboro, IL 62966-2155 | |
| John T Corley | Chiropractic | 716 Walnut St, Murphysboro, IL 62966-2160 | |
| Bobbie L Whitacre | Chiropractic | Murphysboro Chiropractic Clinic, PC | 106 S 14th St, Murphysboro, IL 62966-2515 |
| Jason R Whitacre | Chiropractic | Murphysboro Chiropractic Clinic, PC | 106 S 14th St, Murphysboro, IL 62966-2515 |
| Jeffery W Ripperda | Family Medicine | Shawnee Health Service and Development Corp | 7 S Hospital Dr, Murphysboro, IL 62966-3333 |
| Ana Risse | Family Medicine | Shawnee Health Service and Development Corp | 7 S Hospital Dr, Murphysboro, IL 62966-3333 |
| Clare T Williams | Family Medicine | Shawnee Health Service and Development Corp | 7 S Hospital Dr, Murphysboro, IL 62966-3333 |
| Find all physicians in zip 62966 | |||
| City | MURPHYSBORO |
| Zip Code | 62966 |
| Specialty | FAMILY MEDICINE |
| City + Specialty | MURPHYSBORO + FAMILY MEDICINE |
Please comment or provide details below to improve the information on Dale W Blaise.
| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.