| Mount Vernon Healthy Living Center | |
|
5100 Lake Terrance Ne Mount Vernon IL 62864-9665 | |
| (618) 899-5001 | |
| Not Available |
| Full Name | Mount Vernon Healthy Living Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 5100 Lake Terrance Ne, Mount Vernon, Illinois |
| Authorized Official Name and Position | Jon Leizman (PRESIDENT) |
| Authorized Official Contact | 2164799063 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mount Vernon Healthy Living Center 5500 Maryland Way Ste 120 Brentwood TN 37027-4993 Ph: () - | Mount Vernon Healthy Living Center 5100 Lake Terrance Ne Mount Vernon IL 62864-9665 Ph: (618) 899-5001 |
| NPI Number | 1427366921 |
|---|---|
| Provider Enumeration Date | 09/17/2010 |
| Last Update Date | 08/17/2023 |
| Medicare PECOS PAC ID | 3971764762 |
|---|---|
| Medicare Enrollment ID | O20120423000619 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1427366921 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| 261QX0100X | Clinic/center - Occupational Medicine | (* (Not Available)) | Secondary |
| Provider Name | Mary K Piper |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1881648194 PECOS PAC ID: 6608774260 Enrollment ID: I20031222000206 |
| Provider Name | Jeffrey R Barra |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1679548713 PECOS PAC ID: 4789583279 Enrollment ID: I20040105000107 |
| Provider Name | Susan M Fedinec |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1770549958 PECOS PAC ID: 1052213717 Enrollment ID: I20040126000021 |
| Provider Name | Beverly L Deck |
|---|---|
| Provider Type | Practitioner - Preventive Medicine |
| Provider Identifiers | NPI Number: 1043308828 PECOS PAC ID: 2062476344 Enrollment ID: I20041116000965 |
| Provider Name | Amit Garg |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1760453187 PECOS PAC ID: 3476522350 Enrollment ID: I20041215000344 |
| Provider Name | Diane E Mckenzie |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1750476248 PECOS PAC ID: 2668410630 Enrollment ID: I20050420000656 |
| Provider Name | Susan T Politano |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285724344 PECOS PAC ID: 7719923754 Enrollment ID: I20050630000155 |
| Provider Name | Kavitha Bathala |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1861415747 PECOS PAC ID: 5092722074 Enrollment ID: I20060316000032 |
| Provider Name | Barbara Bellar |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1447309208 PECOS PAC ID: 1951404284 Enrollment ID: I20070307000283 |
| Provider Name | Peggy M Boyd |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1053531541 PECOS PAC ID: 2466548276 Enrollment ID: I20071009000861 |
| Provider Name | Margaret J Janes |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285818070 PECOS PAC ID: 4486736691 Enrollment ID: I20080128000159 |
| Provider Name | Carla M Johns |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1174793012 PECOS PAC ID: 0042388449 Enrollment ID: I20081013000441 |
| Provider Name | Brian L Casaclang |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1093740490 PECOS PAC ID: 1850432006 Enrollment ID: I20100109000255 |
| Provider Name | Deedra G Mclain |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1770635062 PECOS PAC ID: 9234315029 Enrollment ID: I20110511000733 |
| Provider Name | Andrea C Bundy |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1255639563 PECOS PAC ID: 7911179759 Enrollment ID: I20111020000320 |
| Provider Name | Tekekee D Buckner |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1538442918 PECOS PAC ID: 6709052582 Enrollment ID: I20111228000398 |
| Provider Name | Richard Stephen Vogt |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1811258593 PECOS PAC ID: 4082864640 Enrollment ID: I20121017000689 |
| Provider Name | Johnson Vachachira |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1225384092 PECOS PAC ID: 2163676461 Enrollment ID: I20130214000537 |
| Provider Name | Stephanie D Branch |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1508134396 PECOS PAC ID: 3678719143 Enrollment ID: I20130429000636 |
| Provider Name | Kevin J Strohl |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1053652545 PECOS PAC ID: 3577797877 Enrollment ID: I20130927000319 |
| Provider Name | Stacey L Carpenter |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1770819708 PECOS PAC ID: 9638329386 Enrollment ID: I20140121001438 |
| Provider Name | George S Patton |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1891958112 PECOS PAC ID: 3870721483 Enrollment ID: I20140219001802 |
| Provider Name | Mary T Rhodes |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1275954117 PECOS PAC ID: 8325279987 Enrollment ID: I20140324001450 |
| Provider Name | Ruth E Mirza |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992845747 PECOS PAC ID: 8224097274 Enrollment ID: I20150513000815 |
| Provider Name | Leslie S Jones |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1982070942 PECOS PAC ID: 4880994896 Enrollment ID: I20151124000726 |
| Provider Name | Matthew Herring |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1477910446 PECOS PAC ID: 3375846116 Enrollment ID: I20160128000291 |
| Provider Name | Meghan L Hagan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1326412941 PECOS PAC ID: 6709180888 Enrollment ID: I20160210001514 |
| Provider Name | Amanda E Engele |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1033580873 PECOS PAC ID: 3678878584 Enrollment ID: I20160301001351 |
| Provider Name | Lisa K Radville |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1164544813 PECOS PAC ID: 5890092282 Enrollment ID: I20160330001390 |
| Provider Name | Richard W Bousson |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1275919136 PECOS PAC ID: 7618284803 Enrollment ID: I20160505000731 |
| Provider Name | Yaneeth Haro Hilgenberg |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1548663677 PECOS PAC ID: 9537452909 Enrollment ID: I20160721002617 |
| Provider Name | Caleb Daniel |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1336588342 PECOS PAC ID: 7810291390 Enrollment ID: I20160803002318 |
| Provider Name | Max A Baier |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1972589919 PECOS PAC ID: 3173805058 Enrollment ID: I20170130001618 |
| Provider Name | Johann R Serag |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1487987814 PECOS PAC ID: 5890932172 Enrollment ID: I20170302000426 |
| Provider Name | Anna Krok |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1043679525 PECOS PAC ID: 3577848324 Enrollment ID: I20170320000189 |
| Provider Name | Meredith F Walter |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1740736719 PECOS PAC ID: 0446530356 Enrollment ID: I20170911000181 |
| Provider Name | Beth A Fadler |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1083750632 PECOS PAC ID: 1153680715 Enrollment ID: I20180108000366 |
| Provider Name | Anna M Littig |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1376053140 PECOS PAC ID: 7719248418 Enrollment ID: I20180220002167 |
| Provider Name | Amanda J Altobelli |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1417436270 PECOS PAC ID: 0648523647 Enrollment ID: I20181022000019 |
| Provider Name | Resmi Ann George |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952808081 PECOS PAC ID: 8527302546 Enrollment ID: I20181203001438 |
| Provider Name | Mary K Evangelista |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1881114767 PECOS PAC ID: 4981975877 Enrollment ID: I20200805000597 |
| Provider Name | Kimberly Rene Claffey |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194495424 PECOS PAC ID: 9830588086 Enrollment ID: I20211110001079 |
| Provider Name | Megan Foody Skarr |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013348325 PECOS PAC ID: 8527458488 Enrollment ID: I20211208000995 |
| Provider Name | Stayko N Kolev |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1558768119 PECOS PAC ID: 7719370626 Enrollment ID: I20220216001694 |
| Provider Name | Erin Burrell |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1164913737 PECOS PAC ID: 2163837220 Enrollment ID: I20220325001770 |
| Provider Name | Lourdes Sawal Richardson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1669916623 PECOS PAC ID: 1052694759 Enrollment ID: I20220414002216 |
| Provider Name | Lauren Olszewski |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1316672470 PECOS PAC ID: 8628452166 Enrollment ID: I20220831003126 |
| Provider Name | Jonathan Liu |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1750797247 PECOS PAC ID: 5496148835 Enrollment ID: I20230407001001 |
| Provider Name | Matthew Joseph Flosi |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1245808625 PECOS PAC ID: 2567863673 Enrollment ID: I20231122001360 |
Deaconess Il Specialty 4117 Water Tower Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 4117 S Water Tower Pl Ste C, Mount Vernon, IL 62864 Phone: 618-242-0672 Fax: 618-242-0862 | |
Anderson Family Practice Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 3505 Broadway St, Mount Vernon, IL 62864 Phone: 618-244-7788 Fax: 618-244-9330 | |
Deaconess Illinois Clinic, Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 4105 N Water Tower Pl, Mount Vernon, IL 62864 Phone: 812-450-6815 | |
Deaconess Illinois Clinic Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 4117 S Water Tower Pl, Mount Vernon, IL 62864 Phone: 618-242-0672 Fax: 618-242-0862 | |
Deaconess Illinois Clinic Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 4113 S Water Tower Pl, Mount Vernon, IL 62864 Phone: 618-241-9071 Fax: 618-241-9079 | |
King City Physician Company, Llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 4117 S Water Tower Pl, Suite C, Mount Vernon, IL 62864 Phone: 618-242-0672 Fax: 618-242-0862 | |
Crossroads Physician Corp Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 209 Crossroads Pl, Suite 140, Mount Vernon, IL 62864 Phone: 618-241-7207 Fax: 618-241-7210 |