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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: October 25, 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

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 Il Specialty 513 N Main St is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

227

Medicare enrollment records show 227 clinicians reassign Medicare billing to Deaconess Il Specialty 513 N Main St, which bills Medicare for the services they deliver. Of these, 2 practice at this address. Listed here are the 20 practicing nearest to this location.

Clinicians by Medicare Specialty 29

Nurse Practitioner56
Family Practice26
Internal Medicine24
Emergency Medicine19
Hospitalist16
Gastroenterology11
General Surgery9
Urology9
21 other specialties57

Nearest to this location (20)

See all 227
David Ostman
Emergency Medicine
NPI 1053057778
517 N MAIN ST
Anna, IL 62906
(618) 833-4511
✔ PECOS✔ Accepts MedicareSame address
Kathy Schierbaum, APN
Nurse Practitioner
NPI 1700906021
517 N MAIN ST
Anna, IL 62906
(618) 833-2295
✔ PECOS✔ Accepts MedicareSame address
Sujatha Rao, M.D.
Hematology/Oncology
NPI 1356420368
3255 CINNEBAR PT STE 1
Carbondale, IL 62901
(618) 303-2712
✔ PECOS✔ Accepts Medicare18 mi
Mohammed Guba, M.D.
Hospitalist
NPI 1003292624
2 S HOSPITAL DR
Murphysboro, IL 62966
(618) 684-3156
✔ PECOS✔ Accepts Medicare18 mi
Michael Rafati, MD
Emergency Medicine
NPI 1467512848
3114 W SUNSET DR
Carbondale, IL 62901
(618) 549-8935
✔ PECOS✔ Accepts Medicare19 mi
Brandi Anderson, NP
Nurse Practitioner
NPI 1427609775
305 W JACKSON ST STE 103
Carbondale, IL 62901
(618) 351-4972
✔ PECOS✔ Accepts Medicare19 mi
Crystal Honold, RN, MSN, CNRN, CNS
Certified Clinical Nurse Specialist (CNS)
NPI 1609171206
305 W JACKSON ST STE 103
Carbondale, IL 62901
(618) 351-4972
✔ PECOS✔ Accepts Medicare19 mi
Sam Stokes, M.D.
Urology
NPI 1558452144
305 W JACKSON ST STE 301
Carbondale, IL 62901
(618) 351-9300
✔ PECOS✔ Accepts Medicare19 mi
Zubin Wala, MD
Family Practice
NPI 1710502570
300 W OAK ST
Carbondale, IL 62901
(618) 536-6621
✔ PECOS✔ Accepts Medicare19 mi
Jeffrey Lehman, MD
Allergy/Immunology
NPI 1548261399
2601 W MAIN ST
Carbondale, IL 62901
(618) 549-5361
✔ PECOS✔ Accepts Medicare19 mi
Othniel Doolittle, M.D.
Internal Medicine
NPI 1386965499
2250 N ILLINOIS AVE
Carbondale, IL 62901
(618) 833-1691
✔ PECOS✔ Accepts Medicare21 mi
Rhett Macneille, MD
Orthopedic Surgery
NPI 1629574009
510 LINCOLN DRIVE
Herrin, IL 62948
(618) 997-6800
✔ PECOS✔ Accepts Medicare23 mi
Sushilkumar Tibrewala, M.D.
Gastroenterology
NPI 1457366858
3301 PATRIOT CT
Herrin, IL 62948
(618) 998-8885
✔ PECOS✔ Accepts Medicare23 mi
Alejandro Hornik
Neurology
NPI 1134384977
3309 LOGAN DR
Herrin, IL 62948
(615) 549-1882
✔ PECOS✔ Accepts Medicare23 mi
Ma Claravel Criste, M.D.
Pediatric Medicine
NPI 1245486679
2102 WINDSOR DR
Marion, IL 62959
(618) 364-0348
✔ PECOS24 mi
Mitchell Cook, D.P.M.
Podiatry
NPI 1285920835
3329 W DEYOUNG ST
Marion, IL 62959
(618) 767-6050
✔ PECOS✔ Accepts Medicare24 mi
Zaid Al-Dahabrah, MD
Nephrology
NPI 1174194039
3333 W DEYOUNG ST
Marion, IL 62959
(618) 998-7000
✔ PECOS✔ Accepts Medicare24 mi
Qiong Qiu, M.D.
General Surgery
NPI 1629422340
3333 W DEYOUNG ST
Marion, IL 62959
(618) 998-7155
✔ PECOS✔ Accepts Medicare24 mi
Wasey Ali Yadullahi Mir, MD
Pulmonary Disease
NPI 1972098804
3331 W DEYOUNG ST STE 109
Marion, IL 62959
(618) 998-7961
✔ PECOS✔ Accepts Medicare24 mi
Victor Mwansa, M.D
Cardiovascular Disease (Cardiology)
NPI 1811194244
3331 W DEYOUNG ST SUITE 100
Marion, IL 62959
(618) 998-7600
✔ PECOS✔ Accepts Medicare24 mi
See all 227 clinicians

Source: 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 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.

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.

Is Deaconess Illinois Specialty Clinic, Inc. enrolled in Medicare?

Yes. Deaconess Illinois Specialty Clinic, Inc. is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Deaconess Illinois Specialty Clinic, Inc.?

According to the CMS Revalidation Reassignment List (October 2026 release), 227 clinicians in 29 Medicare specialties reassign their Medicare billing to Deaconess Illinois Specialty 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 (56), Family Practice (26) and Internal Medicine (24). Of these, 2 practice at this address. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

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.