DEACONESS ILLINOIS CLINIC, INC
NPI 1063128544
Family Medicine in Mount Vernon, IL
About Deaconess Illinois Clinic, Inc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
DEACONESS ILLINOIS CLINIC, INC (NPI 1063128544), doing business as Deaconess Il Clinic 4105 N Water Tower, is a healthcare organization registered as a family medicine in Mount Vernon, Illinois and active in the NPI registry since January 2023. The organization holds a CLIA Waiver certificate valid through March 1, 2027 and lists Kyle Dillman, Secretary, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Other Names 1
Group Practice 1
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Deaconess Illinois Clinic, Inc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
29Medicare enrollment records show 29 clinicians reassign Medicare billing to Deaconess Illinois Clinic, Inc, which bills Medicare for the services they deliver. Of these, 2 practice at this address and 3 within 10 miles. Listed here are the 20 practicing nearest to this location.
Clinicians by Medicare Specialty 5
Nearest to this location (20)
See all 29Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
CLIA Laboratory Certificates CMS CLIA
Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.
Certificate of Waiver 14D2277676
Deaconess Illinois Clinic Deaconess Illinois Clinic, Inc · Mount Vernon, ILFrequently 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 Deaconess Illinois Clinic, Inc's NPI number?
The NPI number for Deaconess Illinois Clinic, Inc is 1063128544. It was assigned to this organization in the NPPES registry on January 27, 2023. The provider is doing business as Deaconess IL Clinic 4105 N Water Tower.
Where is Deaconess Illinois Clinic, Inc located?
Deaconess Illinois Clinic, Inc is located at 4105 N Water Tower Pl, Mount Vernon, IL 62864. The listed phone number is (812) 450-6815.
What is Deaconess Illinois Clinic, Inc's specialty?
The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.
Is Deaconess Illinois Clinic, Inc enrolled in Medicare?
Yes. Deaconess Illinois Clinic, Inc is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Deaconess Illinois Clinic, Inc?
According to the CMS Revalidation Reassignment List (October 2026 release), 29 clinicians in 5 Medicare specialties reassign their Medicare billing to Deaconess Illinois Clinic, Inc. 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 (18), Family Practice (8) and Emergency Medicine (1). Of these, 2 practice at this address and 3 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Does Deaconess Illinois Clinic, Inc hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 14D2277676) is associated with this NPI, valid through March 1, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
What insurance does Deaconess Illinois Clinic, Inc accept?
Health plans from Ambetter Health and Ambetter Health of Delaware list Deaconess Illinois Clinic, Inc as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.
When was this NPI record last updated?
The NPPES record for Deaconess Illinois Clinic, Inc was last updated on January 27, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 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.
# Deaconess Illinois Clinic, Inc · NPI 1063128544
Family Medicine organization in Mount Vernon, Illinois. Organization record, active in the CMS NPPES registry since January 27, 2023.
## Identity
- **NPI:** 1063128544 (Entity type: Organization)
- **Enumerated:** January 27, 2023
- **Primary specialty:** Family Medicine · taxonomy 207Q00000X
- **Also known as:** Deaconess IL Clinic 4105 N Water Tower (Doing Business As)
- **Organization subpart:** No
- **Authorized official:** Kyle Dillman, SECRETARY
## Practice location
- **Address:** 4105 N WATER TOWER PL, Mount Vernon, IL 62864-6296
- **Phone:** (812) 450-6815
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 29 clinicians in 5 Medicare specialties reassign Medicare billing to this organization (form CMS-855R); largest: Nurse Practitioner (18), Family Practice (8), Emergency Medicine (1); 2 practice at this address and 3 within 10 miles; [full list](https://npiprofile.com/npi/1063128544/clinicians) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** January 27, 2023
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1063128544) · Data from the CMS NPPES public registry.