| Riverside Medical Center | |
|
3400 S Main St. Hopkins Park IL 60944-9998 | |
| (815) 944-5545 | |
| (815) 944-6723 |
| Full Name | Riverside Medical Center |
|---|---|
| Speciality | Family Medicine |
| Location | 3400 S Main St., Hopkins Park, Illinois |
| Authorized Official Name and Position | Patricia K Vilt (CFO) |
| Authorized Official Contact | 8159331671 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Riverside Medical Center Po Box 781 Kankakee IL 60901-0781 Ph: (815) 935-7256 | Riverside Medical Center 3400 S Main St. Hopkins Park IL 60944-9998 Ph: (815) 944-5545 |
| NPI Number | 1982703005 |
|---|---|
| Provider Enumeration Date | 09/22/2006 |
| Last Update Date | 03/29/2024 |
| Medicare PECOS PAC ID | 5991608549 |
|---|---|
| Medicare Enrollment ID | O20040130000202 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1982703005 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Secondary |
| 207Q00000X | Family Medicine | 007 (Illinois) | Primary |
| Provider Name | Stonewall Mccuiston |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1720072143 PECOS PAC ID: 9638150014 Enrollment ID: I20040609001388 |
| Provider Name | Jessica R Boudreau |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1023780673 PECOS PAC ID: 3971992710 Enrollment ID: I20211116001876 |
| Provider Name | Nicholas Cundari |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1265202212 PECOS PAC ID: 7214377837 Enrollment ID: I20240430002744 |
| Provider Name | Isaac Casas |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1578306528 PECOS PAC ID: 1658816814 Enrollment ID: I20240711002588 |
| Provider Name | Kathleen Kleinert |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1689471740 PECOS PAC ID: 9537680616 Enrollment ID: I20250305001872 |