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DEACONESS IL SPECIALTY 513 N MAIN ST
NPI 1134836612
Orthopaedic Surgery in Anna, IL

Active since November 03, 2022CLIA 14D2317473 · Waiver
513 N MAIN ST, ANNA, IL 62906(618) 998-7177(618) 998-7742 Get Directions Write a Review

NPPES record last updated: January 26, 2023. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Jan 26, 2023, Dec 2, 2022, Nov 9, 2022 and 1 more (4 updates tracked since 2022).

About Deaconess Il Specialty 513 N Main St NPPES

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

DEACONESS IL SPECIALTY 513 N MAIN ST (NPI 1134836612) is a healthcare organization registered as an orthopaedic surgery in Anna, Illinois and active in the NPI registry since November 2022. The organization holds a CLIA Waiver certificate valid through January 23, 2027 and lists Kyle Dillman, Secretary Treasurer, as its authorized official.

NPPES Registry Identity

NPI1134836612
Entity TypeOrganization
Primary Taxonomy207X00000X
Legal Business NameDEACONESS ILLINOIS SPECIALTY CLINIC, INC.
Location Address513 N MAIN STAnna, IL 62906-1668
Mailing AddressPo Box 34266Belfast, ME 04915-0620 · (812) 450-6815 · Fax (812) 450-6822
Phone(618) 998-7177
Fax(618) 998-7742
Organization SubpartNo
Authorized OfficialKyle DillmanSecretary Treasurer · (812) 450-7399
Enumeration DateNovember 3, 2022
Last NPPES UpdateJanuary 26, 20234 updates tracked since enumeration
NPPES CertifiedJanuary 26, 2023
✔ NPI 1134836612 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyOrthopaedic SurgeryAllopathic & Osteopathic Physicians
Taxonomy Code207X00000X
Definition
An orthopaedic surgeon is trained in the preservation, investigation and restoration of the form and function of the extremities, spine and associated structures by medical, surgical and physical means. An orthopaedic surgeon is involved with the care of patients whose musculoskeletal problems include congenital deformities, trauma, infections, tumors, metabolic disturbances of the musculoskeletal system, deformities, injuries and degenerative diseases of the spine, hands, feet, knee, hip, shoulder and elbow in children and adults. An orthopaedic surgeon is also concerned with primary and secondary muscular problems and the effects of central or peripheral nervous system lesions of the musculoskeletal system.
513 N MAIN ST, Anna, IL 62906
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Other Names 1

Doing Business AsDeaconess Il Specialty 513 N Main St

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 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 of Waiver 14D2317473

Deaconess Illinois Specialty Clinic · Anna, IL
Active · expires Jan 23, 2027
CLIA Number14D2317473
Laboratory TypePhysician Office
Certificate Effective DateJanuary 24, 2025
Certificate Expiration DateJanuary 23, 2027
Laboratory DirectorMarie J. Gorski
Laboratory Phone(618) 833-2872
Laboratory LocationDeaconess Illinois Specialty Clinic517 N Main St, Anna, IL 62906
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory to perform only waived tests.

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.

MARLA WILLIAMS
Social Worker (Clinical)
513 N MAIN ST
ANNA, IL 62906
Union County (618) 833-4471
RURAL HEALTH, INC.
Case Manager/Care Coordinator
513 N MAIN ST
ANNA, IL 62906
Union County (618) 833-4471
THOMAS J LARKIN III DMD
Dentist
513 N MAIN ST
ANNA, IL 62906
Union County (618) 833-4471
JACOB W RIBBING PA
Physician Assistant
513 N MAIN ST
ANNA, IL 62906
Union County (618) 833-4471
KEITH SAMUEL BASS NP-C
Nurse Practitioner (Family)
513 N MAIN ST
ANNA, IL 62906
Union County (618) 833-4471
DR. MICHAEL PETER HOLUB D.D.S.
Dentist (General Practice)
513 N MAIN ST
ANNA, IL 62906
Union County (618) 833-4471
JEFFREY ALAN SHERRILL PA-C
Physician Assistant (Medical)
513 N MAIN ST
ANNA, IL 62906
Union County (618) 833-4471
WILLIAM GERARD RIBBING M.D.
Family Medicine
513 N MAIN ST
ANNA, IL 62906
Union County (618) 833-4471

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 Deaconess Illinois Specialty Clinic, Inc.'s NPI number?

The NPI number for Deaconess Illinois Specialty Clinic, Inc. is 1134836612. It was assigned to this organization in the NPPES registry on November 3, 2022. The provider is doing business as Deaconess Il Specialty 513 N Main St.

Where is Deaconess Illinois Specialty Clinic, Inc. located?

Deaconess Illinois Specialty Clinic, Inc. is located at 513 N Main St, Anna, IL 62906. The listed phone number is (618) 998-7177.

What is Deaconess Illinois Specialty Clinic, Inc.'s specialty?

The primary specialty registered for this NPI is Orthopaedic Surgery with taxonomy code 207X00000X.

Does Deaconess Illinois Specialty Clinic, Inc. hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 14D2317473) is associated with this NPI, valid through January 23, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Deaconess Illinois Specialty Clinic, Inc. was last updated on January 26, 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.