| 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 | 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 | Donna J Sweetland |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1740374909 PECOS PAC ID: 2860412392 Enrollment ID: I20060109000810 |
| Provider Name | Jeffery W Ripperda |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1306869557 PECOS PAC ID: 4688678873 Enrollment ID: I20060830000382 |
| Provider Name | Aaron Newcomb |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1568636470 PECOS PAC ID: 4587736988 Enrollment ID: I20080630000452 |
| Provider Name | Christina Dothager |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1508067596 PECOS PAC ID: 9133251614 Enrollment ID: I20100719000863 |
| Provider Name | Cheryl a Ellis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1689819435 PECOS PAC ID: 4183808876 Enrollment ID: I20110404000664 |
| Provider Name | Ruthann Coale |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1942425889 PECOS PAC ID: 2567639933 Enrollment ID: I20120125000909 |
| Provider Name | Anna M Little |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1982801742 PECOS PAC ID: 2567633779 Enrollment ID: I20121018000723 |
| 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 | 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 | Ethan Weshinskey |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1457722910 PECOS PAC ID: 3476863390 Enrollment ID: I20151105000862 |
| Provider Name | Christina Trapp |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1780134130 PECOS PAC ID: 7517245293 Enrollment ID: I20161101000281 |
| 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 | 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 | 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 | 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 | Lisa Christine Baranski |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1609499615 PECOS PAC ID: 6406245398 Enrollment ID: I20211115002784 |
| Provider Name | Linda Dodd |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578221719 PECOS PAC ID: 2668863168 Enrollment ID: I20211216001940 |
| 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 | Samantha Herrin |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1245953967 PECOS PAC ID: 4981080363 Enrollment ID: I20221010000112 |
| 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 | 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 | 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 | Tiffany D Allen |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1326525668 PECOS PAC ID: 0345684791 Enrollment ID: I20240214000878 |
| 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 | Gaia Mcvey |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1740476910 PECOS PAC ID: 8224472410 Enrollment ID: I20240215001916 |
| Provider Name | Logan Price |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1720826506 PECOS PAC ID: 4688111487 Enrollment ID: I20240729004441 |
| Provider Name | Haley Brinkley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1962204933 PECOS PAC ID: 4688198468 Enrollment ID: I20250414002889 |
| Provider Name | Erin Shaw |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1982498986 PECOS PAC ID: 9335665942 Enrollment ID: I20250428001334 |
| Provider Name | Emmary S Butler |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1275809311 PECOS PAC ID: 2567605132 Enrollment ID: I20250508000803 |
| Provider Name | Kenzie Lynn Glassburn |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1467026195 PECOS PAC ID: 1355857509 Enrollment ID: I20250723002629 |
| Provider Name | Nicole Jene Fennimore |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1922569748 PECOS PAC ID: 2264769207 Enrollment ID: I20250916003127 |
| Provider Name | Michael Bai-kung Chen |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1023056355 PECOS PAC ID: 5092745992 Enrollment ID: I20250924001434 |
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 |
Murphysboro Wellness Center Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 109 California St, Po Box 577, Carterville, IL 62918 Phone: 618-519-9200 Fax: 618-985-4635 |
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 |