| Passavant Professional Services | |
|
1600 W Walnut St Jacksonville IL 62650-1136 | |
| (217) 245-9541 | |
| (217) 479-8781 |
| Full Name | Passavant Professional Services |
|---|---|
| Speciality | Internal Medicine |
| Location | 1600 W Walnut St, Jacksonville, Illinois |
| Authorized Official Name and Position | Robert L Siltman (DIRECTOR, PATIENT FINCNAIAL SERVICE) |
| Authorized Official Contact | 2174795652 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Passavant Professional Services 1600 W Walnut St Jacksonville IL 62650-1136 Ph: (217) 245-9541 | Passavant Professional Services 1600 W Walnut St Jacksonville IL 62650-1136 Ph: (217) 245-9541 |
| NPI Number | 1760994040 |
|---|---|
| Provider Enumeration Date | 10/26/2017 |
| Last Update Date | 04/09/2018 |
| Medicare PECOS PAC ID | 3173503281 |
|---|---|
| Medicare Enrollment ID | O20180508002390 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760994040 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| 363L00000X | Nurse Practitioner | (* (Not Available)) | Secondary |
| Provider Name | Sterling E Shafer |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1316065873 PECOS PAC ID: 7618920687 Enrollment ID: I20050302000360 |
| Provider Name | David M Beatty |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1568471274 PECOS PAC ID: 7113829433 Enrollment ID: I20070426000471 |
| Provider Name | Peter D Russotto |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1770576829 PECOS PAC ID: 9739268145 Enrollment ID: I20080509000141 |
| Provider Name | Susan K Allen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760631683 PECOS PAC ID: 1658449376 Enrollment ID: I20081008000534 |
| Provider Name | Helen D Kwong |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1346357886 PECOS PAC ID: 6406914316 Enrollment ID: I20081022000088 |
| Provider Name | Blair W Patterson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1841446770 PECOS PAC ID: 0143380964 Enrollment ID: I20081124000083 |
| Provider Name | Charles D Reeve |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1952612822 PECOS PAC ID: 3173775095 Enrollment ID: I20121128000479 |
| Provider Name | Jerel Watson |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1760747406 PECOS PAC ID: 6507005303 Enrollment ID: I20150406002139 |
| Provider Name | Alita Marie Rastello |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1255874392 PECOS PAC ID: 9234419003 Enrollment ID: I20161213002517 |
| Provider Name | Laura A Parrack |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1619414034 PECOS PAC ID: 5991080020 Enrollment ID: I20170331001699 |
| Provider Name | Raymond B. Wynn |
|---|---|
| Provider Type | Practitioner - Radiation Oncology |
| Provider Identifiers | NPI Number: 1548216195 PECOS PAC ID: 2264451392 Enrollment ID: I20170403000863 |
| Provider Name | Alissa B Howard |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1396278255 PECOS PAC ID: 5193096576 Enrollment ID: I20170802003790 |
| Provider Name | Kelly Anne Galanos |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1043627219 PECOS PAC ID: 7810295524 Enrollment ID: I20170913000751 |
| Provider Name | Robert Tennill |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1801215231 PECOS PAC ID: 2062710734 Enrollment ID: I20180615000003 |
| Provider Name | Daniel Brian Savage |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1568889558 PECOS PAC ID: 0244454742 Enrollment ID: I20180626002736 |
| Provider Name | Brittney E Gallivan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1659928646 PECOS PAC ID: 9537498514 Enrollment ID: I20190917002701 |
| Provider Name | Frank B Parks |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1922093731 PECOS PAC ID: 1153219332 Enrollment ID: I20191205000171 |
| Provider Name | Tiffany N Renfro |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285279612 PECOS PAC ID: 0042643603 Enrollment ID: I20191212001273 |
| Provider Name | Aaron M Golitko |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1881122844 PECOS PAC ID: 8022388404 Enrollment ID: I20200325000140 |
| Provider Name | Kenneth Guillotte |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1649709668 PECOS PAC ID: 4880964295 Enrollment ID: I20200408003055 |
| Provider Name | Kirstie Ali Mcgrath |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639708688 PECOS PAC ID: 9234558651 Enrollment ID: I20201002001808 |
| Provider Name | Elias Daniel Trace |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1396237095 PECOS PAC ID: 7618224965 Enrollment ID: I20210602001376 |
| Provider Name | Arthur Chou |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1508359399 PECOS PAC ID: 4284981226 Enrollment ID: I20210629003363 |
| Provider Name | Alexis C Gazda |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1043874761 PECOS PAC ID: 8224360722 Enrollment ID: I20220203000766 |
| Provider Name | Jennifer Lynn Butler |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1710545520 PECOS PAC ID: 7315272614 Enrollment ID: I20220613002422 |
| Provider Name | Sydney Spaulding |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1811587314 PECOS PAC ID: 3971989088 Enrollment ID: I20220927002332 |
| Provider Name | Sierra Lee Dodd |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1184214660 PECOS PAC ID: 7315313327 Enrollment ID: I20221017001573 |
| Provider Name | Gary Hendricks |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1770105249 PECOS PAC ID: 1153745617 Enrollment ID: I20230720000131 |
| Provider Name | Bharat Neelam Raju |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1942736053 PECOS PAC ID: 6103199427 Enrollment ID: I20230816001882 |
Jacksonville Pediatric Associates Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1600 W Walnut St, Jacksonville, IL 62650 Phone: 217-245-5437 Fax: 217-243-3113 | |
Siu Healthcare Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 610 N Westgate Ave, Jacksonville, IL 62650 Phone: 217-243-8455 | |
Central Illinois Snf Care Pllc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1517 W Walnut St, Jacksonville, IL 62650 Phone: 630-336-5620 | |
Springfield Clinic Jacksonville Urgent Care Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1000 W Morton Ave, Jacksonville, IL 62650 Phone: 217-243-6520 | |
Memorial Physician Services Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1602 W Lafayette Ave, Jacksonville, IL 62650 Phone: 217-243-7200 Fax: 217-243-6165 | |
Jacksonville Family Medical Associates Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1602 W Lafayette Ave, Jacksonville, IL 62650 Phone: 217-243-7200 Fax: 217-243-6165 | |
Memorial Physician Services Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1600 W Walnut St, East Wing, 3rd Floor, Jacksonville, IL 62650 Phone: 217-245-5437 Fax: 217-243-3113 |