| Directcare Physician Services, S.c. | |
|
7117 Crimson Ridge Dr Suite 3 Rockford IL 61107-6213 | |
| (815) 633-8099 | |
| (630) 658-0543 |
| Full Name | Directcare Physician Services, S.c. |
|---|---|
| Speciality | Family Medicine |
| Location | 7117 Crimson Ridge Dr, Rockford, Illinois |
| Authorized Official Name and Position | Joseph J Eckburg (PRESIDENT) |
| Authorized Official Contact | 8157516316 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Directcare Physician Services, S.c. 7117 Crimson Ridge Dr Suite 3 Rockford IL 61107-6213 Ph: (815) 316-8700 | Directcare Physician Services, S.c. 7117 Crimson Ridge Dr Suite 3 Rockford IL 61107-6213 Ph: (815) 633-8099 |
| NPI Number | 1780934166 |
|---|---|
| Provider Enumeration Date | 09/13/2012 |
| Last Update Date | 10/31/2019 |
| Medicare PECOS PAC ID | 7719132844 |
|---|---|
| Medicare Enrollment ID | O20130221000242 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780934166 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | (* (Not Available)) | Secondary |
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Rhonda R Johnson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1548388044 PECOS PAC ID: 9638273261 Enrollment ID: I20070409000310 |
| Provider Name | Brandi Kristen Boan |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1780862219 PECOS PAC ID: 9436477338 Enrollment ID: I20150403000837 |
| Provider Name | Samantha A Baney |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1679128730 PECOS PAC ID: 3971831983 Enrollment ID: I20190828001627 |
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