GIBSON RECOVERY OPTIMIZING WELLNESS
NPI 1093448011
Family Medicine - Addiction Medicine in Gibson City, IL

Q: What is Gibson Community Hospital Association's specialty?

The primary specialty registered for this NPI is Family Medicine, specializing in Addiction Medicine, with taxonomy code 207QA0401X.

Active since July 07, 2022CLIA 14D1027353 · Microscopy

10 DOCTORS PARK, GIBSON CITY, IL 60936(217) 784-4251 Get Directions Write a Review

NPPES record last updated: August 2, 2022. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Aug 2, 2022, Jul 7, 2022 (2 updates tracked since 2022).

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About Gibson Recovery Optimizing Wellness NPPES

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

GIBSON RECOVERY OPTIMIZING WELLNESS (NPI 1093448011) is a healthcare organization registered as an addiction medicine in Gibson City, Illinois and active in the NPI registry since July 2022. The organization holds a CLIA Microscopy certificate valid through October 31, 2026 and lists Matthew Ertel, Chief Financial Officer, as its authorized official.

NPPES Registry Identity

NPI1093448011

Entity TypeOrganization

Primary Taxonomy207QA0401X

Legal Business NameGIBSON COMMUNITY HOSPITAL ASSOCIATION

Location Address10 DOCTORS PARKGibson City, IL 60936-2004

Mailing Address1120 N Melvin StGibson City, IL 60936-1477

Phone(217) 784-4251

Organization SubpartYes

Authorized OfficialMatthew ErtelChief Financial Officer · (217) 784-2601

Enumeration DateJuly 7, 2022

Last NPPES UpdateAugust 2, 20222 updates tracked since enumeration

NPPES CertifiedAugust 2, 2022

✔ NPI 1093448011 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily Medicine · Addiction MedicineAllopathic & Osteopathic Physicians

Taxonomy Code207QA0401X

Definition

A family medicine physician who specializes in the diagnosis and treatment of addictions.

10 DOCTORS PARK, Gibson City, IL 60936

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Other Names 1

Doing Business AsGibson Recovery Optimizing Wellness

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X MULTIPLE SINGLE SPECIALTY GROUP

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 for Provider-Performed Microscopy Procedures (PPMP) 14D1027353

Gibson Recovery Optimizing Wellness · Gibson City, IL

Active · expires Oct 31, 2026

CLIA Number14D1027353

Laboratory TypePhysician Office

Certificate Effective DateNovember 1, 2024

Certificate Expiration DateOctober 31, 2026

Laboratory DirectorKatherine Austman MD

Laboratory Phone(217) 784-2807

Laboratory LocationGibson Recovery Optimizing Wellness#10 Doctors Park, Gibson City, IL 60936

CLIA data matches this NPI record on: Name

This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.

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Other Providers at the Same Location NPPES 20

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

MS. REBECCA ANNE WILDERMUTH MS ATC CSCS

Specialist/Technologist (Athletic Trainer)