- Medicare Dental Clinic in Centreville, IL

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is a medicare enrolled dental clinic (Clinic/center - Federally Qualified Health Center (fqhc)) in Centreville, Illinois. The current practice location for is 6000 Bond Ave, Centreville, Illinois. For appointments, you can reach them via phone at (618) 332-2740. The mailing address for is 2041 Goose Lake Rd, Sauget, Illinois and phone number is (618) 332-0953.

is licensed to practice in * (Not Available) (license number ). The clinic also participates in the medicare program and its NPI number is 1609813500. This medical practice accepts medicare insurance (which means this clinic accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance). However, please confirm if they accept your insurance at (618) 332-2740.

Contact Information

6000 Bond Ave
Centreville
IL 62207-2328
(618) 332-2740
(618) 332-8755

Map and Direction


Dental Care Clinic Profile

Full Name
SpecialityClinic/Center
Location6000 Bond Ave, Centreville, Illinois
Authorized Official Name and PositionLarry Mcculley (CHIEF EXECUTIVE OFFICER)
Authorized Official Contact6183320694
Accepts Medicare InsuranceYes. This clinic participates in medicare program and accept medicare insurance.

Mailing Address and Practice Location

Mailing AddressPractice Location Address

2041 Goose Lake Rd
Sauget
IL 62206-2822

Ph: (618) 332-0953
6000 Bond Ave
Centreville
IL 62207-2328

Ph: (618) 332-2740

NPI Details:

NPI Number1609813500
Provider Enumeration Date05/31/2006
Last Update Date05/26/2016

Medicare PECOS Information:

Medicare PECOS PAC ID1456256874
Medicare Enrollment IDO20031126000641

Medical Identifiers

Medical identifiers for such as npi, medicare ID, medicare PIN, medicaid, etc.
IdentifierTypeStateIssuer
1609813500NPI-NPPES

Medical Taxonomies and Licenses

TaxonomyTypeLicense (State)Status
122300000XDentist (* (Not Available))Secondary
207Q00000XFamily Medicine (* (Not Available))Secondary
207R00000XInternal Medicine (* (Not Available))Secondary
207V00000XObstetrics & Gynecology (* (Not Available))Secondary
208000000XPediatrics (* (Not Available))Secondary
2080P0202XPediatrics - Pediatric Cardiology (* (Not Available))Secondary
2080P0207XPediatrics - Pediatric Hematology-oncology (* (Not Available))Secondary
2080P0214XPediatrics - Pediatric Pulmonology (* (Not Available))Secondary
2084N0402XPsychiatry & Neurology - Neurology With Special Qualifications In Child Neurology (* (Not Available))Secondary
261QF0400XClinic/center - Federally Qualified Health Center (fqhc) (* (Not Available))Primary

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. acts as a billing entity for following providers:
Provider NameOladele O Ajao
Provider TypePractitioner - Internal Medicine
Provider IdentifiersNPI Number: 1700829025
PECOS PAC ID: 6002713229
Enrollment ID: I20031216000728
Provider NameJames P Wade
Provider TypePractitioner - Family Practice
Provider IdentifiersNPI Number: 1386640399
PECOS PAC ID: 2163317363
Enrollment ID: I20040217000718
Provider NameKenneth G Reinert
Provider TypePractitioner - Family Practice
Provider IdentifiersNPI Number: 1295781607
PECOS PAC ID: 9133016025
Enrollment ID: I20040304000132
Provider NameMatthew B Wilkinson
Provider TypePractitioner - Internal Medicine
Provider IdentifiersNPI Number: 1821083866
PECOS PAC ID: 5193616134
Enrollment ID: I20040322000300
Provider NameKelly M Farroll
Provider TypePractitioner - Family Practice
Provider IdentifiersNPI Number: 1063503704
PECOS PAC ID: 9931091592
Enrollment ID: I20040327000375
Provider NameMichael C Adams
Provider TypePractitioner - Internal Medicine
Provider IdentifiersNPI Number: 1851383301
PECOS PAC ID: 1153316518
Enrollment ID: I20040419001269
Provider NameBassam M Albarcha
Provider TypePractitioner - Internal Medicine
Provider IdentifiersNPI Number: 1821184193
PECOS PAC ID: 6002802253
Enrollment ID: I20040422001046
Provider NameGeoffrey L Turner
Provider TypePractitioner - Obstetrics/gynecology
Provider IdentifiersNPI Number: 1174619225
PECOS PAC ID: 1355338021
Enrollment ID: I20040427000207
Provider NameHeather Lynne Lucas-foster
Provider TypePractitioner - Family Practice
Provider IdentifiersNPI Number: 1518079243
PECOS PAC ID: 6002870102
Enrollment ID: I20041118000229
Provider NameLuis C Devenecia
Provider TypePractitioner - Internal Medicine
Provider IdentifiersNPI Number: 1750495792
PECOS PAC ID: 2062306194
Enrollment ID: I20050120000433
Provider NameMeher S Mallick
Provider TypePractitioner - Nephrology
Provider IdentifiersNPI Number: 1093789034
PECOS PAC ID: 7911950852
Enrollment ID: I20050303000513
Provider NameDavid P Lebeau
Provider TypePractitioner - Emergency Medicine
Provider IdentifiersNPI Number: 1982707857
PECOS PAC ID: 6406895507
Enrollment ID: I20050428000240
Provider NameRashid A Dalal
Provider TypePractitioner - Nephrology
Provider IdentifiersNPI Number: 1265434815
PECOS PAC ID: 7315982691
Enrollment ID: I20050627001179
Provider NameNarsimha R Muddasani
Provider TypePractitioner - Psychiatry
Provider IdentifiersNPI Number: 1548366263
PECOS PAC ID: 2860465697
Enrollment ID: I20050928000176
Provider NameZehra I Rowjee
Provider TypePractitioner - Psychiatry
Provider IdentifiersNPI Number: 1437252392
PECOS PAC ID: 5193740983
Enrollment ID: I20051011000538
Provider NameSyed A Abdulaziz
Provider TypePractitioner - Cardiovascular Disease (cardiology)
Provider IdentifiersNPI Number: 1114906005
PECOS PAC ID: 9234152588
Enrollment ID: I20060112000494
Provider NameHatim A Mahmood
Provider TypePractitioner - Cardiovascular Disease (cardiology)
Provider IdentifiersNPI Number: 1174556583
PECOS PAC ID: 9830112101
Enrollment ID: I20060112000619
Provider NameMarjorie Helen Guthrie
Provider TypePractitioner - Family Practice
Provider IdentifiersNPI Number: 1366490146
PECOS PAC ID: 8921016015
Enrollment ID: I20060331000158
Provider NameMary R Hoffman
Provider TypePractitioner - Family Practice
Provider IdentifiersNPI Number: 1316984057
PECOS PAC ID: 1850357526
Enrollment ID: I20061116000374
Provider NameDolores J Gunn
Provider TypePractitioner - Family Practice
Provider IdentifiersNPI Number: 1740247360
PECOS PAC ID: 1153368501
Enrollment ID: I20061207000389
Provider NameAnne N Nash
Provider TypePractitioner - Family Practice
Provider IdentifiersNPI Number: 1558440776
PECOS PAC ID: 8628070877
Enrollment ID: I20070201000226
Provider NameChristopher Suhre
Provider TypePractitioner - Pediatric Medicine
Provider IdentifiersNPI Number: 1255350252
PECOS PAC ID: 0244336832
Enrollment ID: I20070427000168
Provider NameEmilia B David-restivo
Provider TypePractitioner - Pediatric Medicine
Provider IdentifiersNPI Number: 1902909492
PECOS PAC ID: 9032210612
Enrollment ID: I20070726000352
Provider NameChristopher Loynd
Provider TypePractitioner - Psychiatry
Provider IdentifiersNPI Number: 1003965955
PECOS PAC ID: 9436184538
Enrollment ID: I20070816000175
Provider NameJanis D Miller
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1356401335
PECOS PAC ID: 5597857797
Enrollment ID: I20070817000206
Provider NameKalyani Gavini
Provider TypePractitioner - Psychiatry
Provider IdentifiersNPI Number: 1730214206
PECOS PAC ID: 6901993120
Enrollment ID: I20071103000095
Provider NameDavid Andrew O'neill
Provider TypePractitioner - Family Practice
Provider IdentifiersNPI Number: 1922092394
PECOS PAC ID: 4284723271
Enrollment ID: I20071128000570
Provider NameTheodore Ross
Provider TypePractitioner - Internal Medicine
Provider IdentifiersNPI Number: 1285720508
PECOS PAC ID: 3971693813
Enrollment ID: I20071217000137
Provider NameRandy J Jung
Provider TypePractitioner - Psychiatry
Provider IdentifiersNPI Number: 1205917176
PECOS PAC ID: 5193805943
Enrollment ID: I20080107000040
Provider NameRise C Hatten
Provider TypePractitioner - Obstetrics/gynecology
Provider IdentifiersNPI Number: 1265499271
PECOS PAC ID: 4789577974
Enrollment ID: I20080530000371
Provider NameAhsan Usman
Provider TypePractitioner - Internal Medicine
Provider IdentifiersNPI Number: 1215016571
PECOS PAC ID: 6507864998
Enrollment ID: I20080823000101
Provider NameSeth W Hahs
Provider TypePractitioner - Internal Medicine
Provider IdentifiersNPI Number: 1154542132
PECOS PAC ID: 1153469770
Enrollment ID: I20091118000589
Provider NameBryan E Steele
Provider TypePractitioner - Family Practice
Provider IdentifiersNPI Number: 1053503045
PECOS PAC ID: 5092854166
Enrollment ID: I20091202000550
Provider NameWilliam R Padgett
Provider TypePractitioner - Obstetrics/gynecology
Provider IdentifiersNPI Number: 1225046253
PECOS PAC ID: 4981598026
Enrollment ID: I20091207000571
Provider NameLeyland A Thomas
Provider TypePractitioner - Internal Medicine
Provider IdentifiersNPI Number: 1922068121
PECOS PAC ID: 9739248071
Enrollment ID: I20100329000371
Provider NameJagannath J Patil
Provider TypePractitioner - Neurology
Provider IdentifiersNPI Number: 1487768917
PECOS PAC ID: 6709868953
Enrollment ID: I20101008001150
Provider NameChristopher V Johnson
Provider TypePractitioner - Psychiatry
Provider IdentifiersNPI Number: 1205975448
PECOS PAC ID: 3870780588
Enrollment ID: I20101207001123
Provider NameMary Carol Agne
Provider TypePractitioner - Family Practice
Provider IdentifiersNPI Number: 1326147935
PECOS PAC ID: 4789872599
Enrollment ID: I20101221000581
Provider NameAristides Juan Garces
Provider TypePractitioner - Family Practice
Provider IdentifiersNPI Number: 1679672273
PECOS PAC ID: 4284822099
Enrollment ID: I20101221000650
Provider NameRoberta C Pritchard Palmer
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1518130707
PECOS PAC ID: 0941489025
Enrollment ID: I20110120001160
Provider NameMiguel H Granger
Provider TypePractitioner - Family Practice
Provider IdentifiersNPI Number: 1265527998
PECOS PAC ID: 3577742659
Enrollment ID: I20110120001178
Provider NameNadeem Ahmed
Provider TypePractitioner - Pulmonary Disease
Provider IdentifiersNPI Number: 1376546804
PECOS PAC ID: 9032029848
Enrollment ID: I20110210000486
Provider NameNanthini Suthan
Provider TypePractitioner - Internal Medicine
Provider IdentifiersNPI Number: 1053504506
PECOS PAC ID: 7719073816
Enrollment ID: I20110223000798
Provider NameAlfred Johnson
Provider TypePractitioner - Family Practice
Provider IdentifiersNPI Number: 1144316431
PECOS PAC ID: 7719169341
Enrollment ID: I20110303000235
Provider NameYetzenia A Arauz
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1366508053
PECOS PAC ID: 3173705886
Enrollment ID: I20110316000436
Provider NameAfshan Sultana
Provider TypePractitioner - Psychiatry
Provider IdentifiersNPI Number: 1073631099
PECOS PAC ID: 1355508672
Enrollment ID: I20120127000994
Provider NameKelechi J N Loynd
Provider TypePractitioner - Psychiatry
Provider IdentifiersNPI Number: 1720104888
PECOS PAC ID: 9335308246
Enrollment ID: I20120313000619
Provider NameDenise J Krone
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1902163942
PECOS PAC ID: 9133382377
Enrollment ID: I20120525000114
Provider NameJames A Fernandez
Provider TypePractitioner - Otolaryngology
Provider IdentifiersNPI Number: 1528037280
PECOS PAC ID: 0446256838
Enrollment ID: I20120530000356
Provider NameBrianna M F Phillips
Provider TypePractitioner - Clinical Social Worker
Provider IdentifiersNPI Number: 1457624108
PECOS PAC ID: 8729242417
Enrollment ID: I20120608000247
Provider NameErin L Friedman
Provider TypePractitioner - Internal Medicine
Provider IdentifiersNPI Number: 1356557698
PECOS PAC ID: 2264599349
Enrollment ID: I20120820001149
Provider NameJacqueline S Aregood
Provider TypePractitioner - Psychiatry
Provider IdentifiersNPI Number: 1154302115
PECOS PAC ID: 3375568389
Enrollment ID: I20130710000488
Provider NameJessica L Epperson
Provider TypePractitioner - Clinical Social Worker
Provider IdentifiersNPI Number: 1033545850
PECOS PAC ID: 6800022518
Enrollment ID: I20131127001603
Provider NameNatascha R Jeffries
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1629409362
PECOS PAC ID: 9032334149
Enrollment ID: I20140703001409
Provider NameBrandy N Holthaus
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1972922953
PECOS PAC ID: 5193947307
Enrollment ID: I20141103001852
Provider NameAutumn Molinari
Provider TypePractitioner - Clinical Social Worker
Provider IdentifiersNPI Number: 1124191283
PECOS PAC ID: 9335462506
Enrollment ID: I20141218001499
Provider NameSang Y Nelson
Provider TypePractitioner - Clinical Social Worker
Provider IdentifiersNPI Number: 1821177056
PECOS PAC ID: 5496078669
Enrollment ID: I20141218001603
Provider NameRebecca Merchiori
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1588068464
PECOS PAC ID: 1254655020
Enrollment ID: I20150127001109
Provider NameBrittany Murry
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1497181333
PECOS PAC ID: 0244559417
Enrollment ID: I20150511000897
Provider NameAmy L Mclean
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1356796874
PECOS PAC ID: 1759671803
Enrollment ID: I20160602001400
Provider NameJanet Lynn Broom
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1740297498
PECOS PAC ID: 5799702833
Enrollment ID: I20160609001048
Provider NameJamie K Bump
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1912250432
PECOS PAC ID: 1355579699
Enrollment ID: I20160609001984
Provider NameHeidi A Fields
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1124473046
PECOS PAC ID: 0345532560
Enrollment ID: I20160708001320
Provider NameSanna M Sundquist
Provider TypePractitioner - Pediatric Medicine
Provider IdentifiersNPI Number: 1861830358
PECOS PAC ID: 9931402716
Enrollment ID: I20160720000080
Provider NameShelley D Reichling
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1144672627
PECOS PAC ID: 6800189002
Enrollment ID: I20160726001722
Provider NameBhawna Sharma
Provider TypePractitioner - Psychiatry
Provider IdentifiersNPI Number: 1134546690
PECOS PAC ID: 2860795929
Enrollment ID: I20160829000708
Provider NameMegha Manek
Provider TypePractitioner - Family Practice
Provider IdentifiersNPI Number: 1841446473
PECOS PAC ID: 4385812007
Enrollment ID: I20160831001535
Provider NameCrystal Vaughn Manse
Provider TypePractitioner - Internal Medicine
Provider IdentifiersNPI Number: 1366702870
PECOS PAC ID: 7618192428
Enrollment ID: I20160906000126
Provider NameChristina L Bereda
Provider TypePractitioner - Family Practice
Provider IdentifiersNPI Number: 1437386083
PECOS PAC ID: 2668622739
Enrollment ID: I20160916000569
Provider NameSharon R Jameson
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1053714998
PECOS PAC ID: 4183921737
Enrollment ID: I20161003000332
Provider NameJamie Lynette Hardman
Provider TypePractitioner - Obstetrics/gynecology
Provider IdentifiersNPI Number: 1093060584
PECOS PAC ID: 3678853504
Enrollment ID: I20161209001269
Provider NameChrista L Metzelaars
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1194270603
PECOS PAC ID: 6305115445
Enrollment ID: I20170706000880
Provider NameChrista K Holmon
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1710406962
PECOS PAC ID: 9335405232
Enrollment ID: I20171109000915
Provider NameMikasa L Crawford
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1316486160
PECOS PAC ID: 2365729399
Enrollment ID: I20180123001193
Provider NameRebecca Ashworth-rhein
Provider TypePractitioner - Clinical Social Worker
Provider IdentifiersNPI Number: 1699178863
PECOS PAC ID: 4789945155
Enrollment ID: I20180227001442
Provider NameJanel Latrice Clark
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1578951752
PECOS PAC ID: 9739495912
Enrollment ID: I20180302000045
Provider NameFelecia V Ernst
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1558864629
PECOS PAC ID: 3072876374
Enrollment ID: I20180419002778
Provider NameDarcy L Graham
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1184081556
PECOS PAC ID: 5395042113
Enrollment ID: I20180927001413
Provider NameBrandy R Whetstone
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1487132387
PECOS PAC ID: 8224381413
Enrollment ID: I20181106001133
Provider NameKylie Lynn Garbe
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1932684313
PECOS PAC ID: 2860746328
Enrollment ID: I20181120000320
Provider NameJames Webb Cole
Provider TypePractitioner - Psychiatry
Provider IdentifiersNPI Number: 1093868127
PECOS PAC ID: 9739260076
Enrollment ID: I20181227002110
Provider NameStaci Lynn Burleyson
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1487159943
PECOS PAC ID: 5991043887
Enrollment ID: I20190220000016
Provider NameTina T Mond
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1043704349
PECOS PAC ID: 7214279777
Enrollment ID: I20190502001038
Provider NameCharles E Scheer
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1346333192
PECOS PAC ID: 2163480369
Enrollment ID: I20190619000130
Provider NameNoah M Cooperstein
Provider TypePractitioner - Family Practice
Provider IdentifiersNPI Number: 1013378652
PECOS PAC ID: 8426346156
Enrollment ID: I20190826000882
Provider NameStephanie L Obrian
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1467005009
PECOS PAC ID: 4284965930
Enrollment ID: I20191010000046
Provider NameYolanda A Suber
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1841842341
PECOS PAC ID: 5698007680
Enrollment ID: I20191023003681
Provider NameShawna L Storm
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1356999262
PECOS PAC ID: 4587096979
Enrollment ID: I20191125001130
Provider NameRebekah E Doty
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1790332450
PECOS PAC ID: 8224461678
Enrollment ID: I20191126000454
Provider NameKelly R Hall
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1912553892
PECOS PAC ID: 9234220989
Enrollment ID: I20191224000248
Provider NameDanielle M Loftus
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1518501451
PECOS PAC ID: 4880022102
Enrollment ID: I20200320001139
Provider NameShadab Muhammad Bhutto
Provider TypePractitioner - Internal Medicine
Provider IdentifiersNPI Number: 1396753018
PECOS PAC ID: 1557389970
Enrollment ID: I20200403001128
Provider NameKayla Ann Pryor
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1093345415
PECOS PAC ID: 6608299318
Enrollment ID: I20200713003228
Provider NameBenjamin C Beggs
Provider TypePractitioner - Family Practice
Provider IdentifiersNPI Number: 1386174381
PECOS PAC ID: 5799105995
Enrollment ID: I20201008001896
Provider NameVinay K Bhooma
Provider TypePractitioner - Family Practice
Provider IdentifiersNPI Number: 1730317702
PECOS PAC ID: 6507014685
Enrollment ID: I20201217001351
Provider NameHeather R Hupperts -harman
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1851999585
PECOS PAC ID: 0345654539
Enrollment ID: I20210129001031
Provider NameMonika Renee Cluney
Provider TypePractitioner - Obstetrics/gynecology
Provider IdentifiersNPI Number: 1982062923
PECOS PAC ID: 3476975947
Enrollment ID: I20210514001864
Provider NameMena Metias
Provider TypePractitioner - Family Practice
Provider IdentifiersNPI Number: 1295229573
PECOS PAC ID: 6406102128
Enrollment ID: I20210713000720
Provider NameAndrew M Gaillardetz
Provider TypePractitioner - Family Practice
Provider IdentifiersNPI Number: 1548764236
PECOS PAC ID: 5799035499
Enrollment ID: I20210719002568
Provider NamePamela R Hughes
Provider TypePractitioner - Family Practice
Provider IdentifiersNPI Number: 1740542588
PECOS PAC ID: 4688803711
Enrollment ID: I20210720003324
Provider NameChristopher R Weisgarber
Provider TypePractitioner - Family Practice
Provider IdentifiersNPI Number: 1427553734
PECOS PAC ID: 1759631500
Enrollment ID: I20210804002580
Provider NameShalease S Adams
Provider TypePractitioner - Family Practice
Provider IdentifiersNPI Number: 1558890590
PECOS PAC ID: 8123390267
Enrollment ID: I20210819000505
Provider NameSarita Sharma
Provider TypePractitioner - Psychiatry
Provider IdentifiersNPI Number: 1134649932
PECOS PAC ID: 0446520076
Enrollment ID: I20210819000578
Provider NameJulie A Creech
Provider TypePractitioner - Family Practice
Provider IdentifiersNPI Number: 1700315520
PECOS PAC ID: 1759716251
Enrollment ID: I20210915003048
Provider NameMina Cunningham
Provider TypePractitioner - Family Practice
Provider IdentifiersNPI Number: 1982191920
PECOS PAC ID: 4284984998
Enrollment ID: I20210927001268
Provider NameSandra Blazek
Provider TypePractitioner - Clinical Social Worker
Provider IdentifiersNPI Number: 1942721295
PECOS PAC ID: 8527390392
Enrollment ID: I20211013002312
Provider NameTina A Winter
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1922676675
PECOS PAC ID: 0941699896
Enrollment ID: I20211115001037
Provider NameJessica Lynn Mccorvey
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1205500246
PECOS PAC ID: 6608265327
Enrollment ID: I20211117002332
Provider NameSafiya Mcneese
Provider TypePractitioner - Family Practice
Provider IdentifiersNPI Number: 1962818823
PECOS PAC ID: 6901024579
Enrollment ID: I20211216000206
Provider NameBrooke E Organ
Provider TypePractitioner - Family Practice
Provider IdentifiersNPI Number: 1295145167
PECOS PAC ID: 4486089984
Enrollment ID: I20211230001558
Provider NameYolanda L Hoag
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1053815423
PECOS PAC ID: 5799032207
Enrollment ID: I20220118002698
Provider NameJenna Churnock
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1285917492
PECOS PAC ID: 2668867672
Enrollment ID: I20220309001958
Provider NameJeremy Cole Hollingsead
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1376000232
PECOS PAC ID: 5597005017
Enrollment ID: I20220314001515
Provider NameJordan Kenneth Marshall
Provider TypePractitioner - General Practice
Provider IdentifiersNPI Number: 1396188025
PECOS PAC ID: 1658509260
Enrollment ID: I20220711002792
Provider NameDorothy N Charles
Provider TypePractitioner - Family Practice
Provider IdentifiersNPI Number: 1194288779
PECOS PAC ID: 9133503907
Enrollment ID: I20220826003052
Provider NameKelli Jan May
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1528793148
PECOS PAC ID: 9436535572
Enrollment ID: I20220927003666
Provider NameJordan Romick
Provider TypePractitioner - Family Practice
Provider IdentifiersNPI Number: 1093219404
PECOS PAC ID: 2769807239
Enrollment ID: I20230113000225
Provider NameDiana L Swanson
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1518625854
PECOS PAC ID: 1355715285
Enrollment ID: I20230316000843
Provider NameBrandon Chase Kruse
Provider TypePractitioner - Internal Medicine
Provider IdentifiersNPI Number: 1386148872
PECOS PAC ID: 1456780170
Enrollment ID: I20230324002320
Provider NameEmma C Clardy
Provider TypePractitioner - Family Practice
Provider IdentifiersNPI Number: 1043847734
PECOS PAC ID: 4789000969
Enrollment ID: I20230905002969
Provider NameJennifer Sedlacek
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1689100083
PECOS PAC ID: 8729352315
Enrollment ID: I20231002002673
Provider NameNelson E Shreve
Provider TypePractitioner - Family Practice
Provider IdentifiersNPI Number: 1720541527
PECOS PAC ID: 6901135946
Enrollment ID: I20231010000288
Provider NamePatrick A Bloecher
Provider TypePractitioner - Family Practice
Provider IdentifiersNPI Number: 1023672409
PECOS PAC ID: 6800123456
Enrollment ID: I20231010000298
Provider NameRoy M Wagner
Provider TypePractitioner - Family Practice
Provider IdentifiersNPI Number: 1477187383
PECOS PAC ID: 4385061977
Enrollment ID: I20231012003079
Provider NameJill Elizabeth Coster
Provider TypePractitioner - Family Practice
Provider IdentifiersNPI Number: 1205462942
PECOS PAC ID: 7810382413
Enrollment ID: I20231013002224
Provider NameJon Elliott D Brubaker
Provider TypePractitioner - Internal Medicine
Provider IdentifiersNPI Number: 1265062178
PECOS PAC ID: 1153752696
Enrollment ID: I20231019003196
Provider NameKenniesha S Hoskins
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1093495012
PECOS PAC ID: 1759738206
Enrollment ID: I20231106002337
Provider NameAshley Nicole Huddlestun
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1083339642
PECOS PAC ID: 1153771035
Enrollment ID: I20231219002984
Provider NameTyler D Thurman
Provider TypePractitioner - Mental Health Counselor
Provider IdentifiersNPI Number: 1053587279
PECOS PAC ID: 9234581596
Enrollment ID: I20240123000984
Provider NameChristal L Gabrielson
Provider TypePractitioner - Mental Health Counselor
Provider IdentifiersNPI Number: 1053714329
PECOS PAC ID: 8628420866
Enrollment ID: I20240123003906
Provider NameMelissa A White
Provider TypePractitioner - Mental Health Counselor
Provider IdentifiersNPI Number: 1285066464
PECOS PAC ID: 5799137113
Enrollment ID: I20240223001103
Provider NameJustin E Hampton
Provider TypePractitioner - Clinical Social Worker
Provider IdentifiersNPI Number: 1184001380
PECOS PAC ID: 9931419942
Enrollment ID: I20240417003891
Provider NameDebra L Huddleston
Provider TypePractitioner - Mental Health Counselor
Provider IdentifiersNPI Number: 1841726379
PECOS PAC ID: 3173962545
Enrollment ID: I20240417004172
Provider NameRenata Shante Caldwell
Provider TypePractitioner - Mental Health Counselor
Provider IdentifiersNPI Number: 1639942220
PECOS PAC ID: 5496194441
Enrollment ID: I20240423003748
Provider NameKelsey M Beard
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1124612445
PECOS PAC ID: 4082156260
Enrollment ID: I20240603002910
Provider NameTierra Q Smith
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1316647753
PECOS PAC ID: 1850833823
Enrollment ID: I20240605002089
Provider NameLori B Harrison
Provider TypePractitioner - Clinical Social Worker
Provider IdentifiersNPI Number: 1861967200
PECOS PAC ID: 8628511706
Enrollment ID: I20240617003843
Provider NameLuke M Conklin
Provider TypePractitioner - Family Practice
Provider IdentifiersNPI Number: 1336641521
PECOS PAC ID: 0749605103
Enrollment ID: I20240702003453
Provider NameMelissa J Sundberg
Provider TypePractitioner - Clinical Social Worker
Provider IdentifiersNPI Number: 1992316608
PECOS PAC ID: 3173060241
Enrollment ID: I20240807000966
Provider NameAlissa L Struble
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1164105490
PECOS PAC ID: 9032657945
Enrollment ID: I20240809002343
Provider NameKasiemobi Bernice Okonkwo
Provider TypePractitioner - Family Practice
Provider IdentifiersNPI Number: 1891365391
PECOS PAC ID: 8628516036
Enrollment ID: I20240816001317
Provider NameNicole Andrea Bennett
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1679163372
PECOS PAC ID: 6406397710
Enrollment ID: I20240926000042
Provider NameChiagoziem J Ndulue
Provider TypePractitioner - Family Practice
Provider IdentifiersNPI Number: 1780173864
PECOS PAC ID: 4880020130
Enrollment ID: I20240927001918
Provider NameJessica A Reuss
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1427532100
PECOS PAC ID: 1951832559
Enrollment ID: I20241007003879
Provider NameMary Kathleen Gibbons
Provider TypePractitioner - Mental Health Counselor
Provider IdentifiersNPI Number: 1124481312
PECOS PAC ID: 2567996556
Enrollment ID: I20241113003194

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Dental Clinics in Centreville, IL


Medicare Program: Medicare is a federal government program which provides health insurance to people who are 65 or older. This program also covers certain younger people with disabilities (who receive Social Security Disability Insurance - SSDI), and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD.

Medicare Assignment: Assignment means that your doctor, provider, or supplier agrees (or is required by law) to accept the Medicare-approved amount as full payment for covered services. Most doctors, providers, and suppliers accept assignment, but you should always check to make sure. Participating providers have signed an agreement to accept assignment for all Medicare-covered services.

NPI Number: The National Provider Identifier (NPI) is a unique identification number for covered health care providers. The NPI must be used in lieu of legacy provider identifiers in the HIPAA standards transactions. Covered health care providers and all health plans and health care clearinghouses must use the NPIs in the administrative and financial transactions adopted under HIPAA (Health Insurance Portability and Accountability Act).

Our Data: Information on www.medicarelist.com is built using data sources published by Centers for Medicare & Medicaid Services (CMS) under Freedom of Information Act (FOIA). The information disclosed on the NPI Registry are FOIA-disclosable and are required to be disclosed under the FOIA and the eFOIA amendments to the FOIA. There is no way to 'opt out' or 'suppress' the NPPES record data for health care providers with active NPIs.