THE SPORTS & PHYSICAL MEDICINE CLINIC @ ST. MARY'S
NPI 1174702708
Physician Assistant in Decatur, IL
NPI Status: Active since October 31, 2007
Contact Information
1900 E LAKE SHORE DR
SUITE 200
DECATUR, IL
ZIP 62521
Phone: (217) 464-1030
Fax: (217) 464-1039
- Organization
- Physician Assistant
About THE SPORTS & PHYSICAL MEDICINE CLINIC @ ST. MARY'S
This page provides the complete NPI Profile along with additional information for The Sports & Physical Medicine Clinic @ St. Mary's, a primary care provider established in Decatur, Illinois operating as a Physician Assistant. The healthcare provider is registered in the NPI registry with number 1174702708 assigned on October 2007. The practitioner's primary taxonomy code is 363A00000X with license number 085-003034 (IL). The provider is registered as an organization and their NPI record was last updated one year ago. The organization operates as a single speciality business group with one or more individual providers who practice the same area of specialization. The provider's is doing business as The Sports & Physical Medicine Clinic @ St. Mary's. The authorized official of this NPI record is Mark D Evard (Vp Of Revenue Cycle)
- NPI
- 1174702708
- Provider Legal Name
- ST MARYS HOSPITAL DECATUR OF THE HOSPITAL SISTERS OF THE THIRD ORDER
- Other Organization Name
- THE SPORTS & PHYSICAL MEDICINE CLINIC @ ST. MARY'S
- Other Name Type
- Doing Business As (3)
- Entity Type
- Organization
- Location Address
- 1900 E LAKE SHORE DR SUITE 200 DECATUR, IL 62521
- Location Phone
- (217) 464-1030
- Location Fax
- (217) 464-1039
- Mailing Address
- 3051 HOLLIS DR SPRINGFIELD, IL 62704
- Mailing Phone
- (217) 464-2966
- Mailing Fax
- (217) 464-1039
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 10-31-2007
- Last Update Date
- 10-31-2024
- Code Navigator
A primary care provider (PCP) like The Sports & Physical Medicine Clinic @ St. Mary's sees people with common medical problems. The primary care provider might be a doctor, physician assistant, nurse practitioner or clinic that are usually involved in your long-term care. A PCP might provide preventive care, treat common medical conditions, identify urgent medical problems and refer you to specialists when necessary. Primary care is usually provided in an outpatient facility but if you are admitted to a hospital your PCP may assist in your care. The most common medical conditions seen by primary care providers are: hypertension, upper respiratory tract infections, depression or anxiety, back pain, arthritis, dermatitis, diabetes, urinary tract infections, etc .
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Physician Assistant
- Taxonomy Code
- 363A00000X
- Type
- Physician Assistants & Advanced Practice Nursing Providers
- License No.
- 085-003034
- License State
- IL
- Taxonomy Description
- A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.
Group Taxonomy 193400000X SINGLE SPECIALTY GROUP
This provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.
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NPI Validation Check Digit Calculation
The following table explains the step by step NPI number validation process using the ISO standard Luhn algorithm.
| Start with the original NPI number, the last digit is the check digit and is not used in the calculation. | |||||||||
| 1 | 1 | 7 | 4 | 7 | 0 | 2 | 7 | 0 | 8 |
| Step 1: Double the value of the alternate digits, beginning with the rightmost digit. | |||||||||
| 2 | 1 | 14 | 4 | 14 | 0 | 4 | 7 | 0 | |
| Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24. | |||||||||
| 2 + 1 + 1 + 4 + 4 + 1 + 4 + 0 + 4 + 7 + 0 + 24 = 52 | |||||||||
| Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit. | |||||||||
| 60 - 52 = 8 | 8 | ||||||||
The NPI number 1174702708 is valid because the calculated check digit 8 using the Luhn validation algorithm matches the last digit of the original NPI number.
Other Providers at the Same Location
The following 16 providers are registered at the same or nearby location.
| NPI | Name / Type | Taxonomy | Address |
|---|---|---|---|
| 1700888609 | MARIA RIZALIN GALIT FLICKINGER MD Individual | Obstetrics & Gynecology | 1900 E LAKE SHORE DR STE 350 DECATUR, IL 62521 (217) 423-2800 |
| 1558316273 | MISS ANGELA DURFEY MS, ATC, L Individual | Specialist/Technologist (Athletic Trainer) | 1900 E LAKE SHORE DR DECATUR, IL 62521 (217) 428-6222 |
| 1730128026 | MR. ROBERT HILL MS, ATC, L Individual | Specialist/Technologist (Athletic Trainer) | 1900 E LAKE SHORE DR DECATUR, IL 62521 (217) 428-6222 |
| 1508805649 | MRS. KAREN HILL PT, CERT. MDT Individual | Physical Therapist | 1900 E LAKE SHORE DR SUITE 150 DECATUR, IL 62521 (217) 428-6222 |
| 1124067376 | MRS. PAMELA MUELLER P.T.A. Individual | Physical Therapy Assistant | 1900 E LAKE SHORE DR DECATUR, IL 62521 (217) 428-6222 |
| 1487693214 | MRS. JENNIFER JOHNSTON PT, CERT. MDT Individual | Physical Therapist | 1900 E LAKE SHORE DR DECATUR, IL 62521 (217) 428-6222 |
| 1144437195 | DAVID L HOLTZSCHER ATC Individual | Specialist/Technologist (Athletic Trainer) | 1900 E LAKE SHORE DR SUITE 150 DECATUR, IL 62521 (217) 428-6222 |
| 1790961977 | KARE4KIDS SC Organization | Pediatrics | 1900 E LAKE SHORE DR SUITE 330 DECATUR, IL 62521 (217) 423-2889 |
| 1316253578 | MRS. LINDA S PIETRZAK NP Individual | Nurse Practitioner (Pediatrics) | 1900 E LAKE SHORE DR SUITE 330 DECATUR, IL 62521 (217) 423-2889 |
| 1811274889 | SHERRIE KNUTSON ATC Individual | Specialist/Technologist (Athletic Trainer) | 1900 E LAKE SHORE DR DECATUR, IL 62521 (217) 464-5970 |
| 1306238746 | CRYSTAL LOUISE ZEIGLER ATC Individual | Specialist/Technologist (Athletic Trainer) | 1900 E LAKE SHORE DR DECATUR, IL 62521 (217) 464-5970 |
| 1881935435 | DEEPTHI SEEKURI MANOJ M.D Individual | Pediatrics | 1900 E LAKE SHORE DR DECATUR, IL 62521 (217) 423-2889 |
| 1639458623 | TRACY PULLIAM LCSW Individual | Social Worker (Clinical) | 1900 E LAKE SHORE DR SUITE 201 DECATUR, IL 62521 (217) 422-0027 |
| 1174594717 | SPORTS MEDICINE CLINIC OF MACON COUNTY Organization | Physical Therapist | 1900 E LAKE SHORE DR SUITE 150 DECATUR, IL 62521 (217) 428-6222 |
| 1861680704 | MR. ZACHARY LEE SOWA P.A. Individual | Physician Assistant | 1900 E LAKE SHORE DR SUITE 200 DECATUR, IL 62521 (217) 464-1030 |
| 1255397592 | MR. CRAIG W. DEVERELL ATC, CSCS Individual | Specialist/Technologist (Athletic Trainer) | 1900 E LAKE SHORE DR SUITE 150 DECATUR, IL 62521 (217) 428-6222 |
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1174702708, enumerated in the NPI registry as an "organization" on October 31, 2007
The provider is located at 1900 E Lake Shore Dr Suite 200 Decatur, Il 62521 and the phone number is (217) 464-1030
This medical organization specializes in Physician Assistant with taxonomy code 363A00000X
This NPI record was last updated on October 31, 2007. To officially update your NPI information contact the National Plan and Provider Enumeration System (NPPES) at 1-800-465-3203 (NPI Toll-Free) or by email at [email protected].
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