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SHAWNEE HEALTH SOCIAL SERVICES
NPI 1053002907
Clinic/Center - Federally Qualified Health Center (FQHC) in Carterville, IL

Active since May 19, 2023
6355 BRANDHORST RD, CARTERVILLE, IL 62918(618) 519-9200(618) 985-9096 Get Directions Write a Review

NPPES record last updated: July 16, 2024. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Jul 16, 2024, Apr 5, 2024, May 19, 2023 (3 updates tracked since 2023).

About Shawnee Health Social Services NPPES

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

SHAWNEE HEALTH SOCIAL SERVICES (NPI 1053002907) is a healthcare organization registered as a federally qualified health center (fqhc) in Carterville, Illinois and active in the NPI registry since May 2023. The organization lists Christina Carney, Ceo, as its authorized official.

NPPES Registry Identity

NPI1053002907
Entity TypeOrganization
Primary Taxonomy261QF0400X
Legal Business NameSHAWNEE HEALTH SERVICE AND DEVELOPMENT CORP
Location Address6355 BRANDHORST RDCarterville, IL 62918-3322
Mailing AddressPo Box 577Carterville, IL 62918-0577 · (618) 985-8221 · Fax (618) 985-6860
Phone(618) 519-9200
Fax(618) 985-9096
Organization SubpartYes
Authorized OfficialChristina CarneyCeo · (618) 956-9521
Enumeration DateMay 19, 2023
Last NPPES UpdateJuly 16, 20243 updates tracked since enumeration
NPPES CertifiedJuly 16, 2024
✔ NPI 1053002907 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyClinic/Center · Federally Qualified Health Center (FQHC)Ambulatory Health Care Facilities
Taxonomy Code261QF0400X
Also ListedCounselor · Mental HealthTaxonomy 101YM0800X
Also ListedSocial Worker · ClinicalTaxonomy 1041C0700X
6355 BRANDHORST RD, Carterville, IL 62918
Open in Google Maps ↗

Other Names 1

Doing Business AsShawnee Health Social Services

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

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Shawnee Health Social Services is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

52

Medicare enrollment records show 52 clinicians reassign Medicare billing to Shawnee Health Social Services, which bills Medicare for the services they deliver. Of these, 1 practice at this address and 37 within 10 miles. Listed here are the 20 practicing nearest to this location.

Clinicians by Medicare Specialty 8

Nurse Practitioner15
Family Practice8
Certified Nurse Midwife (CNM)7
Obstetrics/Gynecology7
Clinical Social Worker6
Mental Health Counselor5
Internal Medicine2
Registered Dietitian or Nutrition Professional2

Nearest to this location (20)

See all 52
Ryan Rogulich, LCSW
Clinical Social Worker
NPI 1427713403
6355 BRANDHORST RD
Carterville, IL 62918
(618) 519-9200
✔ PECOSSame address
Kaif Mansuri, M.D.
Family Practice
NPI 1326429242
1006 S DIVISION ST
Carterville, IL 62918
(618) 519-9200
✔ PECOS✔ Accepts Medicare2.0 mi
Amanda Reynolds, APN
Nurse Practitioner
NPI 1952785222
1006 S DIVISION ST
Carterville, IL 62918
(618) 519-9200
✔ PECOS✔ Accepts Medicare2.0 mi
David Vaccaro, MSW, LCSW
Clinical Social Worker
NPI 1548852437
1006 S DIVISION ST
Carterville, IL 62918
(618) 519-9200
✔ PECOS✔ Accepts Medicare2.0 mi
Teresa Johnson, APRN
Nurse Practitioner
NPI 1639690191
1006 S DIVISION ST
Carterville, IL 62918
(618) 519-9200
✔ PECOS✔ Accepts Medicare2.0 mi
Matin Nekzad, MD
Family Practice
NPI 1679548689
1006 S DIVISION ST
Carterville, IL 62918
(618) 985-4841
✔ PECOS✔ Accepts Medicare2.0 mi
Katie Surman, RD
Registered Dietitian or Nutrition Professional
NPI 1033038005
1006 S DIVISION ST
Carterville, IL 62918
(618) 519-9200
✔ Accepts Medicare2.0 mi
Haley Brinkley, APRN
Nurse Practitioner
NPI 1962204933
3111 WILLIAMSON COUNTY PKWY
Marion, IL 62959
(618) 519-9200
✔ PECOS✔ Accepts Medicare3.3 mi
Lindsey Falmier, LCSW
Clinical Social Worker
NPI 1386356699
3111 WILLIAMSON COUNTY PKWY
Marion, IL 62959
(618) 519-9200
✔ PECOS✔ Accepts Medicare3.3 mi
Michael Parks, LCSW
Clinical Social Worker
NPI 1932818044
3111 WILLIAMSON COUNTY PKWY
Marion, IL 62959
(618) 519-9200
✔ PECOS✔ Accepts Medicare3.3 mi
Jill Piper, MS LCPC
Mental Health Counselor
NPI 1427164821
3111 WILLIAMSON COUNTY PKWY
Marion, IL 62959
(618) 519-9200
✔ PECOS3.3 mi
Liudmila Vasilets, MD
Internal Medicine
NPI 1225525579
3111 WILLIAMSON COUNTY PKWY
Marion, IL 62959
(618) 519-9200
✔ PECOS✔ Accepts Medicare3.3 mi
Gaia Mcvey, LCPC
Mental Health Counselor
NPI 1740476910
1220 S PARK AVE
Herrin, IL 62948
(618) 988-1757
✔ PECOS✔ Accepts Medicare4.7 mi
Crystina Wells
Mental Health Counselor
NPI 1477118974
1602 W WALNUT ST
Marion, IL 62959
(618) 364-2504
✔ PECOS✔ Accepts Medicare5.5 mi
Ashley Whitecotton, APRN
Nurse Practitioner
NPI 1326529660
1700 WILDCAT DR STE A
Marion, IL 62959
(618) 519-9200
✔ PECOS✔ Accepts Medicare5.8 mi
Kara Flatt, APN
Nurse Practitioner
NPI 1295819381
1700 WILDCAT DR STE A
Marion, IL 62959
(618) 519-9200
✔ PECOS✔ Accepts Medicare7.1 mi
Renee Feather, MD
Family Practice
NPI 1528478559
400 S LEWIS LN
Carbondale, IL 62901
(618) 519-9200
✔ PECOS✔ Accepts Medicare8.8 mi
Anna Little, MD
Internal Medicine
NPI 1982801742
400 S LEWIS LN
Carbondale, IL 62901
(618) 519-9900
✔ PECOS✔ Accepts Medicare8.8 mi
Elizabeth Jolliff, CNM
Certified Nurse Midwife (CNM)
NPI 1366013013
101 S WALL ST
Carbondale, IL 62901
(618) 519-9200
✔ PECOS✔ Accepts Medicare9.3 mi
Kenzie Glassburn, MD
Obstetrics/Gynecology
NPI 1467026195
101 S WALL ST
Carbondale, IL 62901
(618) 519-9200
✔ PECOS✔ Accepts Medicare9.3 mi
See all 52 clinicians

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

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 Shawnee Health Service And Development Corp's NPI number?

The NPI number for Shawnee Health Service And Development Corp is 1053002907. It was assigned to this organization in the NPPES registry on May 19, 2023. The provider is doing business as Shawnee Health Social Services.

Where is Shawnee Health Service And Development Corp located?

Shawnee Health Service And Development Corp is located at 6355 Brandhorst Rd, Carterville, IL 62918. The listed phone number is (618) 519-9200.

What is Shawnee Health Service And Development Corp's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Federally Qualified Health Center (FQHC), with taxonomy code 261QF0400X.

Is Shawnee Health Service And Development Corp enrolled in Medicare?

Yes. Shawnee Health Service And Development Corp is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Shawnee Health Service And Development Corp?

According to the CMS Revalidation Reassignment List (October 2026 release), 52 clinicians in 8 Medicare specialties reassign their Medicare billing to Shawnee Health Service And Development Corp. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. The largest specialties are Nurse Practitioner (15), Family Practice (8) and Certified Nurse Midwife (CNM) (7). Of these, 1 practice at this address and 37 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

When was this NPI record last updated?

The NPPES record for Shawnee Health Service And Development Corp was last updated on July 16, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 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.