| Shawnee Health Service And Development Corp | |
|
109 California St Carterville IL 62918-0577 | |
| (618) 985-8221 | |
| (618) 985-6860 |
| Full Name | Shawnee Health Service And Development Corp |
|---|---|
| Speciality | Clinic/Center |
| Location | 109 California St, Carterville, Illinois |
| Authorized Official Name and Position | Christina Carney (CEO) |
| Authorized Official Contact | 6189569521 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Shawnee Health Service And Development Corp 109 California St P O Box 577 Carterville IL 62918-0577 Ph: (618) 985-8221 | Shawnee Health Service And Development Corp 109 California St Carterville IL 62918-0577 Ph: (618) 985-8221 |
| NPI Number | 1639295314 |
|---|---|
| Provider Enumeration Date | 03/22/2007 |
| Last Update Date | 04/05/2024 |
| Certification Date | 04/05/2024 |
| Medicare PECOS PAC ID | 1658285671 |
|---|---|
| Medicare Enrollment ID | O20031120000454 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639295314 | NPI | - | NPPES |
| 022 | Medicaid | IL | |
| 020 | Medicaid | IL | |
| 640701 | Other | MEDICARE PART B GROUP ID | |
| 10032052 | Other | IL | BLUE CROSS BLUE SHIELD |
| CF3444 | Other | IL | MEDICARE RAILROAD |
| 013 | Medicaid | IL | |
| 024 | Medicaid | IL | |
| 018 | Medicaid | IL | |
| 019 | Medicaid | IL |
| Provider Name | Sherry L Jones |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1912908906 PECOS PAC ID: 1557356789 Enrollment ID: I20040417000233 |
| Provider Name | Francis H Tsung |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1700870987 PECOS PAC ID: 5294701413 Enrollment ID: I20040908001185 |
| Provider Name | Clare T Williams |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1932146271 PECOS PAC ID: 0547237752 Enrollment ID: I20040915001107 |
| Provider Name | Matin Nekzad |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1679548689 PECOS PAC ID: 6002852878 Enrollment ID: I20050701000109 |
| Provider Name | Darlene S Lutchka |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1760429146 PECOS PAC ID: 5092749952 Enrollment ID: I20050921000342 |
| Provider Name | Jeffery W Ripperda |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1306869557 PECOS PAC ID: 4688678873 Enrollment ID: I20060830000382 |
| Provider Name | Amanda D Mulch |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1609927870 PECOS PAC ID: 8921109406 Enrollment ID: I20070727000482 |
| Provider Name | Aaron Newcomb |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1568636470 PECOS PAC ID: 4587736988 Enrollment ID: I20080630000452 |
| Provider Name | Catherine C Schneider |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1518951813 PECOS PAC ID: 4385777556 Enrollment ID: I20100809000914 |
| Provider Name | Anna M Little |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1982801742 PECOS PAC ID: 2567633779 Enrollment ID: I20121018000723 |
| Provider Name | Danielle K Tomevi |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1962645937 PECOS PAC ID: 2365682226 Enrollment ID: I20130717000601 |
| Provider Name | Felicia D Kimbrough |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1679740708 PECOS PAC ID: 2961643408 Enrollment ID: I20130726000176 |
| Provider Name | Amanda J Bowers |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1942620372 PECOS PAC ID: 3870719255 Enrollment ID: I20140721000653 |
| Provider Name | Yvonne Daniels |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1801280573 PECOS PAC ID: 8921310798 Enrollment ID: I20150708000252 |
| Provider Name | Amanda Reynolds |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952785222 PECOS PAC ID: 3375859887 Enrollment ID: I20150828001685 |
| Provider Name | Nicole Davis |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1871975938 PECOS PAC ID: 4688980808 Enrollment ID: I20150903000256 |
| Provider Name | Laura Castillo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1275905374 PECOS PAC ID: 7517260177 Enrollment ID: I20160114002981 |
| Provider Name | Tiffany Todd |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1134582471 PECOS PAC ID: 6406155621 Enrollment ID: I20160422000132 |
| Provider Name | Megan Walker |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1013464692 PECOS PAC ID: 2860773280 Enrollment ID: I20161227000234 |
| Provider Name | Gerald Steven Martin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1770014748 PECOS PAC ID: 5799060158 Enrollment ID: I20170327001444 |
| Provider Name | Tasmeer Hassan |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1801201538 PECOS PAC ID: 0244502565 Enrollment ID: I20170822001948 |
| Provider Name | Renee B Feather |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1528478559 PECOS PAC ID: 0244505139 Enrollment ID: I20171003004834 |
| Provider Name | Brandi J Swift |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1164939070 PECOS PAC ID: 8628338282 Enrollment ID: I20180131000931 |
| Provider Name | Kaif M Mansuri |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1326429242 PECOS PAC ID: 6709199656 Enrollment ID: I20180725000771 |
| Provider Name | Kowsika Movva |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1023490950 PECOS PAC ID: 2567775406 Enrollment ID: I20180727000169 |
| Provider Name | Barenya Mukerji |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1730594615 PECOS PAC ID: 9436401122 Enrollment ID: I20181008001879 |
| Provider Name | Kara Danielle Flatt |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1295819381 PECOS PAC ID: 1850643594 Enrollment ID: I20181009000570 |
| Provider Name | Ashley Whitecotton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1326529660 PECOS PAC ID: 7315291945 Enrollment ID: I20181116000994 |
| Provider Name | Teresa Johnson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639690191 PECOS PAC ID: 0042557845 Enrollment ID: I20190201001502 |
| Provider Name | Rachael Johnson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1306317383 PECOS PAC ID: 5395084073 Enrollment ID: I20190223000049 |
| Provider Name | Holly Gates |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1063991206 PECOS PAC ID: 7618201500 Enrollment ID: I20190626003031 |
| Provider Name | Jessica Baine |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1548815293 PECOS PAC ID: 7719217017 Enrollment ID: I20190930003136 |
| Provider Name | Rachael Wernsman |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1417590639 PECOS PAC ID: 9133451743 Enrollment ID: I20191031002403 |
| Provider Name | Kristin Mcdonald |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609401405 PECOS PAC ID: 4789013137 Enrollment ID: I20200406001552 |
| Provider Name | Jessica N Rigg |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710586128 PECOS PAC ID: 4486066347 Enrollment ID: I20201217001011 |
| Provider Name | Meghan Jo Shackleton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1700495819 PECOS PAC ID: 2365854239 Enrollment ID: I20201217001158 |
| Provider Name | Mckenzie Bonifield |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205411204 PECOS PAC ID: 1355758061 Enrollment ID: I20210325000273 |
| Provider Name | David Vaccaro |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1548852437 PECOS PAC ID: 2961810122 Enrollment ID: I20210428001191 |
| Provider Name | Ruth Karnes |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1083387450 PECOS PAC ID: 5991100570 Enrollment ID: I20210819001658 |
| Provider Name | Liudmila Vasilets |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1225525579 PECOS PAC ID: 7911304761 Enrollment ID: I20210922001118 |
| Provider Name | Amanda Williams |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1881363000 PECOS PAC ID: 0244638468 Enrollment ID: I20211001001426 |
| Provider Name | Linda Dodd |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578221719 PECOS PAC ID: 2668863168 Enrollment ID: I20211216001940 |
| Provider Name | Maria Barbagallo |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1669127312 PECOS PAC ID: 5294120077 Enrollment ID: I20220314000872 |
| Provider Name | Nicole P Waters |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1407416308 PECOS PAC ID: 2769717040 Enrollment ID: I20220510001024 |
| Provider Name | Elizabeth Anne Jolliff |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1366013013 PECOS PAC ID: 4981081635 Enrollment ID: I20220518001040 |
| Provider Name | Shannon M Denman |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1902536428 PECOS PAC ID: 0749660132 Enrollment ID: I20220701000433 |
| Provider Name | Morgan Leigh Torrez |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1700371762 PECOS PAC ID: 6305190653 Enrollment ID: I20220720002125 |
| Provider Name | John Keehn |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1275265100 PECOS PAC ID: 7416333810 Enrollment ID: I20221010000575 |
| Provider Name | Michael Shayne Parks |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1932818044 PECOS PAC ID: 1355710666 Enrollment ID: I20221208001589 |
| Provider Name | Hans Roethling |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1629059704 PECOS PAC ID: 1557494093 Enrollment ID: I20230117001156 |
| Provider Name | Molly Quinn |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1588226203 PECOS PAC ID: 7012388408 Enrollment ID: I20230123000979 |
| Provider Name | Lindsey Falmier |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1386356699 PECOS PAC ID: 6507237773 Enrollment ID: I20230126000463 |
| Provider Name | Jessica Nicole Reichert |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1790400661 PECOS PAC ID: 0042675993 Enrollment ID: I20230427001138 |
| Provider Name | Meredith Wild |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1275237745 PECOS PAC ID: 1759746480 Enrollment ID: I20230502000353 |
| Provider Name | Jennifer Ting |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1912687336 PECOS PAC ID: 9133582091 Enrollment ID: I20230825001615 |
| Provider Name | Ryan Rogulich |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1427713403 PECOS PAC ID: 2365896677 Enrollment ID: I20230920001989 |
| Provider Name | Poorva Talapatra |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1013210194 PECOS PAC ID: 1355784794 Enrollment ID: I20240213001574 |
| Provider Name | Alexandria Markel |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1487111852 PECOS PAC ID: 2062855422 Enrollment ID: I20240213002440 |
| Provider Name | Tiffany D Allen |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1326525668 PECOS PAC ID: 0345684791 Enrollment ID: I20240214000878 |
| Provider Name | Amanda Rushing |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1215455472 PECOS PAC ID: 7012351323 Enrollment ID: I20240214003026 |
| Provider Name | Jill Kathleen Piper |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1427164821 PECOS PAC ID: 0941644272 Enrollment ID: I20240214003777 |
| Provider Name | Lindsay Miller |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1023774056 PECOS PAC ID: 7618311804 Enrollment ID: I20240215001796 |
| Provider Name | Gaia Mcvey |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1740476910 PECOS PAC ID: 8224472410 Enrollment ID: I20240215001916 |
Shawnee Health Social Services Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 6355 Brandhorst Rd, Carterville, IL 62918 Phone: 618-519-9200 Fax: 618-985-9096 | |
Centerstone Of Illinois, Inc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 403 Municipal Dr, Carterville, IL 62918 Phone: 855-608-3560 | |
Solutions Counseling & Education Inc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 209 W Commercial Dr, Suite H, Carterville, IL 62918 Phone: 618-985-1072 Fax: 618-985-1076 | |
Centerstone Of Illinois, Inc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 403 Municipal Dr, Carterville, IL 62918 Phone: 618-937-6483 | |
Carbondale Counseling Associates Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 209 W Commercial Dr Ste H, Carterville, IL 62918 Phone: 618-351-9700 Fax: 618-351-9701 | |
Mobile Unit 1 Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 109 California St, Carterville, IL 62918 Phone: 618-519-9200 | |
Centerstone Of Illinois Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 403 Municipal Dr, Carterville, IL 62918 Phone: 855-608-3561 |