Ellie Marie Bentley (NPI# 1093157315, PAC ID# 4587993019) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is GENERAL SURGERY.
Nation Provider ID (NPI) | 1093157315 |
PAC ID by PECOS | 4587993019 |
Professional Enrollment ID | I20190910000114 |
Full Name | Ellie Marie Bentley |
Organization Legal Name | SOUTHERN ILLINOIS MEDICAL SERVICES, NFP |
Address |
220 S Park Ave Suite 3 Herrin IL 62948-3612 |
Phone Number | 618942200235767 |
Gender | F |
Medical School | LAKE ERIE COLLEGE OF OSTEOPATHIC MEDICINE |
Graduation Year | 2013 |
Primary Specialty | GENERAL SURGERY |
Group Practice PAC ID | 3678677390 |
Number of Group Practice Members | 325 |
Accepts Medicare Assignment | Y |
Claim Control Number (CCN) | Legal Business Name |
---|---|
140011 | SOUTHERN ILLINOIS HOSPITAL SERVICES DBA HERRIN HOSPITAL |
140164 | MEMORIAL HOSPITAL OF CARBONDALE |
Address | Phone | Organization |
---|---|---|
220 S Park Ave, Suite 3, Herrin, IL 62948-3612 | 618942200235767 | SOUTHERN ILLINOIS MEDICAL SERVICES, NFP |
Organization Legal Name | SOUTHERN ILLINOIS MEDICAL SERVICES, NFP |
Physicians | 338 |
Name | Specialty | Organization | Address |
---|---|---|---|
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 |
Amy Nichole Dinga | Nurse Practitioner | Southern Illinois Medical Services, Nfp | 1400 Financial Park Dr, Carbondale, IL 62901 |
Street Address |
220 S PARK AVE SUITE 3 |
City | HERRIN |
State | IL |
Zip | 62948-3612 |
Name | Specialty | Organization | Address |
---|---|---|---|
Nikita Chevalier | Urology | Southern Illinois Medical Services, Nfp | 220 S Park Ave, Suite 2, Herrin, IL 62948-3612 |
Benjamin P Roose | General Surgery | Southern Illinois Medical Services, Nfp | 220 S Park Ave, Suite 3, Herrin, IL 62948-3612 |
Brett Michael Dempsey | General Surgery | Southern Illinois Medical Services, Nfp | 220 S Park Ave, Suite 3, Herrin, IL 62948-3612 |
Aimee Michelle Belt | Nurse Practitioner | Southern Illinois Medical Services, Nfp | 220 S Park Ave, Suite 2, Herrin, IL 62948-3612 |
Name | Specialty | Organization | Address |
---|---|---|---|
Trevor Crabtree | Optometry | Paul C Jacobs Trevor Crabtree Ptr | 223 N Park Ave, Herrin, IL 62948-3149 |
Gerri Dyer | Nurse Practitioner | Southern Illinois Dermatology, PC | 220 N Park Ave, Suite 2, Herrin, IL 62948-3150 |
Kelly D Chullen | Chiropractic | 120 E Herrin St, Total Health Chiropractic, Herrin, IL 62948-3163 | |
Nova M Griffith | Psychologist, Clinical | 121 N 13th St, Suite 2, Herrin, IL 62948-3255 | |
Motaz R Wraikat | Undersea and Hyperbaric Medicine | Southern Illinois Medical Services, Nfp | 315 S 14th St, Suite 3, Herrin, IL 62948-3601 |
Sahitya Settypalli | Undersea and Hyperbaric Medicine | Southern Illinois Medical Services, Nfp | 315 S 14th St, Suite 3, Herrin, IL 62948-3601 |
William Fix | Optometry | Marion Eye Centers Ltd | 321 S Park Ave, Herrin, IL 62948-3603 |
Mohammed Lawan Gana Guba | Hospitalist | Southern Illinois Medical Services, Nfp | 201 S 14th St, Herrin, IL 62948-3631 |
Siena Elisa Nadal Ona | Physical Medicine and Rehabilitation | Medical Services Ric | 201 S 14th St, Herrin, IL 62948-3631 |
Gerald W Mcclallen | Emergency Medicine | Southern Illinois Medical Services, Nfp | 201 S 14th St, Herrin, IL 62948-3631 |
Find all physicians in zip 62948 |
City | HERRIN |
Zip Code | 62948 |
Specialty | GENERAL SURGERY |
City + Specialty | HERRIN + GENERAL SURGERY |
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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.