| Charles K Boley, | |
|
10 Saint Clare Ct Ste 100, Washington, IL 61571-9239 | |
| (309) 886-4000 | |
| (309) 886-4118 |
| Full Name | Charles K Boley |
|---|---|
| Gender | Male |
| Speciality | Internal Medicine |
| Experience | 22 Years |
| Location | 10 Saint Clare Ct Ste 100, Washington, Illinois |
| Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912126640 | NPI | - | NPPES |
| P00401636 | Other | RR MEDICARE | |
| 833230 | Other | 833230 - PONTIAC GROUP # | |
| CA4079 | Other | RR GROUP | |
| 036115574 | Medicaid | IL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 036-115574 (Illinois) | Primary |
| 208000000X | Pediatrics | 036-115574 (Illinois) | Secondary |
| Facility Name | Location | Facility Type |
|---|---|---|
| St. Francis Medical Center | Peoria, IL | Home health agency |
| Saint Francis Medical Center | Peoria, IL | Hospital |
| Saint James Hospital | Pontiac, IL | Hospital |
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|---|---|
| Osf Multi-specialty Group | 3678889789 | 1848 |
| Entity Name | Osf Multi-specialty Group |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1922445527 PECOS PAC ID: 3678889789 Enrollment ID: O20150904000279 |
| Mailing Address | Practice Location Address |
|---|---|
| Charles K Boley, 10 Saint Clare Ct Ste 100, Washington, IL 61571-9239 Ph: (309) 886-4000 | Charles K Boley, 10 Saint Clare Ct Ste 100, Washington, IL 61571-9239 Ph: (309) 886-4000 |
Mallory Kelly, M.D. Internal Medicine Medicare: Medicare Enrolled Practice Location: 1113 Dixon St, Washington, IL 61571 Phone: 217-502-2672 | |
Matthew Gorman, Internal Medicine Medicare: Accepting Medicare Assignments Practice Location: 10 Saint Clare Ct, Washington, IL 61571 Phone: 309-886-4000 Fax: 309-886-4101 | |
Dr. Jay Tyler Rohde, MD Internal Medicine Medicare: Accepting Medicare Assignments Practice Location: 10 Saint Clare Ct, Washington, IL 61571 Phone: 309-886-4000 | |
David Hall, Internal Medicine Medicare: Not Enrolled in Medicare Practice Location: 10 Saint Clare Ct, Washington, IL 61571 Phone: 309-886-4000 Fax: 309-886-4101 | |
Lynessa A Alonso, D.O. Internal Medicine Medicare: Medicare Enrolled Practice Location: 10 Saint Clare Ct, Washington, IL 61571 Phone: 309-886-4003 | |
Rhett Miller, Internal Medicine Medicare: Accepting Medicare Assignments Practice Location: 10 Saint Clare Ct, Washington, IL 61571 Phone: 309-886-4000 Fax: 309-886-4101 |