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MAIN STREET MEDICAL GROUP LLC
NPI 1043832769
General Practice in O Fallon, IL

Active since May 15, 2020
124 REGENCY PARK STE 7, O FALLON, IL 62269(480) 926-2260 Get Directions Write a Review

NPPES record last updated: May 4, 2021. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: May 4, 2021, Feb 10, 2021, May 15, 2020 (3 updates tracked since 2020).

About Main Street Medical Group Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MAIN STREET MEDICAL GROUP LLC (NPI 1043832769) is a healthcare organization registered as a general practice in O Fallon, Illinois and active in the NPI registry since May 2020. The organization lists Ellie Descalzo, Credentialing Officer, as its authorized official.

NPPES Registry Identity

NPI1043832769
Entity TypeOrganization
Primary Taxonomy208D00000X
Legal Business NameMAIN STREET MEDICAL GROUP LLC
Location Address124 REGENCY PARK STE 7O Fallon, IL 62269-1994
Mailing Address2250 E Germann Rd Ste 8Chandler, AZ 85286-1575 · (480) 926-7800
Phone(480) 926-2260
Organization SubpartNo
Authorized OfficialEllie DescalzoCredentialing Officer · (480) 926-7800
Enumeration DateMay 15, 2020
Last NPPES UpdateMay 4, 20213 updates tracked since enumeration
NPPES CertifiedMay 4, 2021
✔ NPI 1043832769 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 6

★ Primary SpecialtyGeneral PracticeAllopathic & Osteopathic Physicians
Taxonomy Code208D00000X
Definition
A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee
Also ListedChiropractorTaxonomy 111N00000X
Also ListedInternal MedicineTaxonomy 207R00000X
Also ListedPhysical TherapistTaxonomy 225100000X
Also ListedPhysician AssistantTaxonomy 363A00000X
Also ListedNurse Practitioner · FamilyTaxonomy 363LF0000X
124 REGENCY PARK STE 7, O Fallon, IL 62269
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Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Other Providers at the Same Location NPPES 5

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

REGENCY PARK MEDICAL GROUP LLC
General Practice
124 REGENCY PARK STE 7
O FALLON, IL 62269
St. Clair County (480) 926-7800
NEW HEIGHTS INTEGRATED HEALTH SC
Clinic/Center (Multi-Specialty)
124 REGENCY PARK STE 7
O FALLON, IL 62269
St. Clair County (618) 622-3322
NEW HEIGHTS CHIROPRACTIC
Chiropractor
124 REGENCY PARK STE 7
O FALLON, IL 62269
St. Clair County (618) 570-9173
SCHANTZ MEDICAL GROUP LLC
General Practice
124 REGENCY PARK STE 7
O FALLON, IL 62269
St. Clair County (480) 926-2260
O FALLON MEDICAL VENTURES LLC
General Practice
124 REGENCY PARK STE 7
O FALLON, IL 62269
St. Clair County (480) 926-2260

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Main Street Medical Group LLC's NPI number?

The NPI number for Main Street Medical Group LLC is 1043832769. It was assigned to this organization in the NPPES registry on May 15, 2020.

Where is Main Street Medical Group LLC located?

Main Street Medical Group LLC is located at 124 Regency Park Ste 7, O Fallon, IL 62269. The listed phone number is (480) 926-2260.

What is Main Street Medical Group LLC's specialty?

The primary specialty registered for this NPI is General Practice with taxonomy code 208D00000X.

When was this NPI record last updated?

The NPPES record for Main Street Medical Group LLC was last updated on May 4, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.