| Mcdonough Medical Group (mmg) | |
|
525 E Grant St Macomb IL 61455-3313 | |
| (309) 833-4101 | |
| Not Available |
| Full Name | Mcdonough Medical Group (mmg) |
|---|---|
| Speciality | Internal Medicine |
| Location | 525 E Grant St, Macomb, Illinois |
| Authorized Official Name and Position | Linda K. Dace (VP FINANCE) |
| Authorized Official Contact | 3098334101 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mcdonough Medical Group (mmg) P.o. Box 1179 525 East Grant St Macomb IL 61455 Ph: (309) 833-4101 | Mcdonough Medical Group (mmg) 525 E Grant St Macomb IL 61455-3313 Ph: (309) 833-4101 |
| NPI Number | 1609180082 |
|---|---|
| Provider Enumeration Date | 07/28/2010 |
| Last Update Date | 01/17/2017 |
| Medicare PECOS PAC ID | 0446140180 |
|---|---|
| Medicare Enrollment ID | O20090407000082 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609180082 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 0001438 (Illinois) | Primary |
| Provider Name | Idol R Mitchell |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1508850694 PECOS PAC ID: 6507763984 Enrollment ID: I20031215000432 |
| Provider Name | Scott Wright |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1447258181 PECOS PAC ID: 3577453596 Enrollment ID: I20040316000150 |
| Provider Name | Noel L Flores |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1316921000 PECOS PAC ID: 7315838844 Enrollment ID: I20040324001180 |
| Provider Name | Brenda Powell -allen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1538164447 PECOS PAC ID: 0143241901 Enrollment ID: I20051208000693 |
| Provider Name | Susan E Adams |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1922004332 PECOS PAC ID: 0143244392 Enrollment ID: I20060116000187 |
| Provider Name | Ronald Wheeler |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1053328831 PECOS PAC ID: 3375567860 Enrollment ID: I20060124000252 |
| Provider Name | Goldwyn Foggie |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1013925387 PECOS PAC ID: 0547366288 Enrollment ID: I20070426000284 |
| Provider Name | Edwin L Card |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1568468015 PECOS PAC ID: 3173611019 Enrollment ID: I20071112000018 |
| Provider Name | Amy L Adams |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1508049552 PECOS PAC ID: 0941386023 Enrollment ID: I20080331000016 |
| Provider Name | Thomas H Patterson |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1568460970 PECOS PAC ID: 4082605225 Enrollment ID: I20100202000410 |
| Provider Name | Daniel J Lee |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1588751135 PECOS PAC ID: 6800981838 Enrollment ID: I20110128000924 |
| Provider Name | Eric Vincent Reinertson |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1497825863 PECOS PAC ID: 3779756739 Enrollment ID: I20111227000606 |
| Provider Name | Yousaf Jalil |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1629384136 PECOS PAC ID: 8224204805 Enrollment ID: I20120103000469 |
| Provider Name | Gina S Bell |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1760501225 PECOS PAC ID: 9335233972 Enrollment ID: I20120130000955 |
| Provider Name | Dan E Ruiz |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1134374929 PECOS PAC ID: 8527210129 Enrollment ID: I20121205000502 |
| Provider Name | Irma E Funes |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578817003 PECOS PAC ID: 0941446009 Enrollment ID: I20130415000407 |
| Provider Name | Tamara M Smith |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1932118239 PECOS PAC ID: 9436100666 Enrollment ID: I20130628000768 |
| Provider Name | Sajjad R Sarwar |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1982839957 PECOS PAC ID: 5294975249 Enrollment ID: I20130716000029 |
| Provider Name | Jeffrey R Sparks |
|---|---|
| Provider Type | Practitioner - Otolaryngology |
| Provider Identifiers | NPI Number: 1780935197 PECOS PAC ID: 8123253044 Enrollment ID: I20131031001267 |
| Provider Name | Heather M Harrison |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1497929798 PECOS PAC ID: 5193969525 Enrollment ID: I20131213000727 |
| Provider Name | Chukwudi C Nwawka |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1891961066 PECOS PAC ID: 2062640386 Enrollment ID: I20140114000385 |
| Provider Name | Kirsten D Clerkin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730515578 PECOS PAC ID: 4789813478 Enrollment ID: I20140128001895 |
| Provider Name | Mary C Thompson |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1518263714 PECOS PAC ID: 3072743251 Enrollment ID: I20140310000602 |
| Provider Name | Brittney L Taylor |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447675889 PECOS PAC ID: 0042443806 Enrollment ID: I20140501000054 |
| Provider Name | Krystal L Nelson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1245634963 PECOS PAC ID: 8123341633 Enrollment ID: I20150107002281 |
| Provider Name | Richard Minter |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1518036979 PECOS PAC ID: 6406972306 Enrollment ID: I20160203001013 |
| Provider Name | Jodi Heller |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1497114029 PECOS PAC ID: 2769788868 Enrollment ID: I20160316001363 |
| Provider Name | Melanie L Banal |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1770986010 PECOS PAC ID: 2567684012 Enrollment ID: I20160506001023 |
| Provider Name | Prayag Patel |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1295175487 PECOS PAC ID: 5294025243 Enrollment ID: I20160908003004 |
| Provider Name | Megan Clemens |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1093268724 PECOS PAC ID: 9234425356 Enrollment ID: I20160915000968 |
| Provider Name | Kaye Stone |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1982050415 PECOS PAC ID: 1658667795 Enrollment ID: I20160915001492 |
| Provider Name | Kamie Mckee |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1407300627 PECOS PAC ID: 8820384985 Enrollment ID: I20160915002302 |
| Provider Name | Layne Stambaugh |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1487016010 PECOS PAC ID: 9830486596 Enrollment ID: I20160922002685 |
| Provider Name | Brianne L Wehner |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1003171968 PECOS PAC ID: 0749411627 Enrollment ID: I20161003000431 |
| Provider Name | Lyndsay Bedwell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518315811 PECOS PAC ID: 7113215062 Enrollment ID: I20161010002212 |
| Provider Name | Haseena Mazhar Ali |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1851738769 PECOS PAC ID: 4587942735 Enrollment ID: I20161024001054 |
| Provider Name | Aphrodite Henderson |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1861471450 PECOS PAC ID: 0547302366 Enrollment ID: I20170717000414 |
| Provider Name | Afriye R Amerson |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1952305229 PECOS PAC ID: 9537294301 Enrollment ID: I20171005001614 |
| Provider Name | Kelsi D Cunningham |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023531142 PECOS PAC ID: 2769744986 Enrollment ID: I20180327001977 |
| Provider Name | Chanda L Reese |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1508038019 PECOS PAC ID: 6103090063 Enrollment ID: I20180418002734 |
| Provider Name | Donna C Jensen |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1689676736 PECOS PAC ID: 9436311222 Enrollment ID: I20180730001224 |
| Provider Name | Christina Jane Chambers |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1467017749 PECOS PAC ID: 6103159306 Enrollment ID: I20190603001841 |
| Provider Name | Lemuel G Villanueva |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1336107978 PECOS PAC ID: 1153499967 Enrollment ID: I20190603002486 |
| Provider Name | Jolaiya Faturoti |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1588074611 PECOS PAC ID: 9739425521 Enrollment ID: I20190702001070 |
| Provider Name | Steven Coulter |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1689626046 PECOS PAC ID: 5294722757 Enrollment ID: I20190930000827 |
| Provider Name | Michelle D Sullivan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1629530399 PECOS PAC ID: 2264761048 Enrollment ID: I20191101001095 |
| Provider Name | Sarah Beth Skiles |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1538702477 PECOS PAC ID: 3870926009 Enrollment ID: I20191202002780 |
| Provider Name | Brittany A Cromer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578194965 PECOS PAC ID: 0143657056 Enrollment ID: I20200304002764 |
| Provider Name | Christina M Kelly |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1295389385 PECOS PAC ID: 7012347511 Enrollment ID: I20200424000602 |
| Provider Name | Robert C Glenn |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1902033210 PECOS PAC ID: 9335328467 Enrollment ID: I20200622001680 |
| Provider Name | Margaret L Tate |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1215467154 PECOS PAC ID: 2163788043 Enrollment ID: I20200622002940 |
| Provider Name | Nicholas G Viyuoh |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1952410219 PECOS PAC ID: 2466348263 Enrollment ID: I20200917001531 |
| Provider Name | Sreyram Kuy |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1932343514 PECOS PAC ID: 2860774437 Enrollment ID: I20210616000725 |
| Provider Name | Laura Peck |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1699159558 PECOS PAC ID: 7416265269 Enrollment ID: I20211203000762 |
| Provider Name | Derenda Beasley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1386120343 PECOS PAC ID: 3072934512 Enrollment ID: I20220418002180 |
| Provider Name | Deborah L Garrelts-daoud |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1215025309 PECOS PAC ID: 0749313054 Enrollment ID: I20220512001642 |
| Provider Name | Jennifer Lynn Lemaster |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1669050738 PECOS PAC ID: 8022499227 Enrollment ID: I20220719003454 |
| Provider Name | Olivia Marie White |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1124557939 PECOS PAC ID: 2062782451 Enrollment ID: I20220920000103 |
| Provider Name | Jenna E Settles |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265151955 PECOS PAC ID: 4688043482 Enrollment ID: I20221219001259 |
| Provider Name | Emily S Mynatt |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356066310 PECOS PAC ID: 9133599251 Enrollment ID: I20230106001489 |
| Provider Name | Simi Dhillon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205423688 PECOS PAC ID: 5092124610 Enrollment ID: I20230719001984 |
| Provider Name | Annette Marie Holt |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1659888428 PECOS PAC ID: 3678832375 Enrollment ID: I20230907000655 |
| Provider Name | Kellie Sue Jones |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730861055 PECOS PAC ID: 6507213980 Enrollment ID: I20231107000269 |
| Provider Name | Alissa Sue Fisk |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1467954974 PECOS PAC ID: 1850742776 Enrollment ID: I20240614001773 |
Mcdonough Medical Group Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 505 E Grant St, Suite 202, Macomb, IL 61455 Phone: 309-833-4101 Fax: 309-836-1525 | |
Macomb Internal Medicine Ltd Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 515 E Grant St, Ste 111, Macomb, IL 61455 Phone: 309-837-9926 Fax: 309-833-1417 | |
Family Practice Associates Of Macomb Ltd Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 505 E Grant St, Suite 110 Family Practice Associates Of Macomb Ltd, Macomb, IL 61455 Phone: 309-833-1733 Fax: 309-836-2369 | |
Mcdonough County Hospital District Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 515 E Grant St Ste 213, Macomb, IL 61455 Phone: 309-837-6937 Fax: 309-837-1979 | |
Mdh Convenient Care Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1600 E Jackson St, Macomb, IL 61455 Phone: 309-833-4101 | |
Medical Group Of Macomb, Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 505 E Grant St Ste 103, Macomb, IL 61455 Phone: 309-833-3536 Fax: 309-836-5729 | |
Mcdonough Medical Group Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 515 E Grant St, Macomb, IL 61455 Phone: 309-837-2414 Fax: 309-837-2170 |