1. Home
  2. Directory
  3. Illinois
  4. Marion
  5. Family Medicine
  6. NPI Profile

DEACONESS IL SPECIALTY EXPRESS 2700 DEYOUNG
NPI 1134836695
Family Medicine in Marion, IL

Active since November 03, 2022CLIA 14D2146145 · Waiver
2700 W DEYOUNG ST STE F, MARION, IL 62959(618) 969-8633(618) 969-8639 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 Express 2700 Deyoung NPPES

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

DEACONESS IL SPECIALTY EXPRESS 2700 DEYOUNG (NPI 1134836695) is a healthcare organization registered as a family medicine in Marion, Illinois and active in the NPI registry since November 2022. The organization holds a CLIA Waiver certificate valid through March 21, 2028 and lists Kyle Dillman, Secretary Treasurer, as its authorized official.

NPPES Registry Identity

NPI1134836695
Entity TypeOrganization
Primary Taxonomy207Q00000X
Legal Business NameDEACONESS ILLINOIS SPECIALTY CLINIC, INC.
Location Address2700 W DEYOUNG ST STE FMarion, IL 62959-4943
Mailing AddressPo Box 34266Belfast, ME 04915-0620 · (812) 450-6815 · Fax (812) 450-6822
Phone(618) 969-8633
Fax(618) 969-8639
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 1134836695 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
Definition
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
Also ListedPhysician AssistantTaxonomy 363A00000X
Also ListedNurse PractitionerTaxonomy 363L00000X
2700 W DEYOUNG ST STE F, Marion, IL 62959
Open in Google Maps ↗

Other Names 1

Doing Business AsDeaconess Il Specialty Express 2700 Deyoung

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)

Deaconess Il Specialty Express 2700 Deyoung 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 Express 2700 Deyoung, which bills Medicare for the services they deliver. Of these, 3 practice at this address and 42 within 10 miles. 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
Heather Alexander, FNP-BC
Nurse Practitioner
NPI 1992439293
2700 W DEYOUNG ST STE F
Marion, IL 62959
(618) 998-7000
✔ PECOS✔ Accepts MedicareSame address
Joshme Rawal, APRN
Nurse Practitioner
NPI 1174249593
2700 W DEYOUNG ST STE F
Marion, IL 62959
(618) 969-8633
✔ PECOSSame address
Kara Tipsword, FNP-C
Nurse Practitioner
NPI 1689363509
2700 W DEYOUNG ST STE F
Marion, IL 62959
(618) 969-8633
✔ PECOS✔ Accepts MedicareSame address
Raymund Pineda, M.D.
Pulmonary Disease
NPI 1841262789
2401 W MAIN ST
Marion, IL 62959
(618) 997-5311
✔ PECOS✔ Accepts Medicare1.1 mi
Michelle Mc Lain, APN
Nurse Practitioner
NPI 1104102474
3333 W DEYOUNG ST
Marion, IL 62959
(618) 998-7947
✔ PECOS1.4 mi
Qiong Qiu, M.D.
General Surgery
NPI 1629422340
3333 W DEYOUNG ST
Marion, IL 62959
(618) 998-7155
✔ PECOS✔ Accepts Medicare1.4 mi
Joshua Richardson, FNP-C
Nurse Practitioner
NPI 1306322136
3333 W DEYOUNG ST
Marion, IL 62959
(618) 998-7000
✔ PECOS✔ Accepts Medicare1.4 mi
Zaid Al-Dahabrah, MD
Nephrology
NPI 1174194039
3333 W DEYOUNG ST
Marion, IL 62959
(618) 998-7000
✔ PECOS✔ Accepts Medicare1.4 mi
Marie Gorski, MD
General Surgery
NPI 1841374873
3331 W DEYOUNG ST STE 305
Marion, IL 62959
(618) 998-7155
✔ PECOS✔ Accepts Medicare1.4 mi
Victor Mwansa, M.D
Cardiovascular Disease (Cardiology)
NPI 1811194244
3331 W DEYOUNG ST SUITE 100
Marion, IL 62959
(618) 998-7600
✔ PECOS✔ Accepts Medicare1.4 mi
Wasey Ali Yadullahi Mir, MD
Pulmonary Disease
NPI 1972098804
3331 W DEYOUNG ST STE 109
Marion, IL 62959
(618) 998-7961
✔ PECOS✔ Accepts Medicare1.4 mi
Amar Rawal, MD
Urology
NPI 1538591268
3331 W DEYOUNG ST
Marion, IL 62959
(618) 998-8884
✔ PECOS✔ Accepts Medicare1.4 mi
Mitchell Cook, D.P.M.
Podiatry
NPI 1285920835
3329 W DEYOUNG ST
Marion, IL 62959
(618) 767-6050
✔ PECOS✔ Accepts Medicare1.7 mi
Jodi Fox, M.D.
Family Practice
NPI 1508848284
3411 PROFESSIONAL PARK DR
Marion, IL 62959
(618) 997-2161
✔ PECOS✔ Accepts Medicare1.7 mi
Clinton Mohr, M.D.
Internal Medicine
NPI 1356427736
1008 W CHERRY ST STE D
Marion, IL 62959
(618) 997-2396
✔ PECOS✔ Accepts Medicare1.8 mi
Ma Claravel Criste, M.D.
Pediatric Medicine
NPI 1245486679
2102 WINDSOR DR
Marion, IL 62959
(618) 364-0348
✔ PECOS2.0 mi
William Gray, D.O.
Hospitalist
NPI 1114378882
405 W JACKSON ST
Carbondale, IL 62901
(615) 549-0721
✔ PECOS✔ Accepts Medicare2.4 mi
Mack Mccain, M.D.
Gastroenterology
NPI 1558321190
404 LINCOLN DR
Herrin, IL 62948
(618) 993-0056
✔ PECOS✔ Accepts Medicare3.4 mi
Alejandro Hornik
Neurology
NPI 1134384977
3309 LOGAN DR
Herrin, IL 62948
(615) 549-1882
✔ PECOS✔ Accepts Medicare3.5 mi
Rhett Macneille, MD
Orthopedic Surgery
NPI 1629574009
510 LINCOLN DRIVE
Herrin, IL 62948
(618) 997-6800
✔ PECOS✔ Accepts Medicare3.5 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 14D2146145

Deaconess Illinois Specialty Clinic Express · Marion, IL
Active · expires Mar 21, 2028
CLIA Number14D2146145
Laboratory TypeUrgent Care
Certificate Effective DateMarch 22, 2026
Certificate Expiration DateMarch 21, 2028
Laboratory DirectorSabrina Stevens
Laboratory Phone(618) 969-8633
Laboratory LocationDeaconess Illinois Specialty Clinic Express2700 W De Young St, Marion, IL 62959
CLIA data matches this NPI record on: Name Phone
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 1134836695. It was assigned to this organization in the NPPES registry on November 3, 2022. The provider is doing business as Deaconess Il Specialty Express 2700 Deyoung.

Where is Deaconess Illinois Specialty Clinic, Inc. located?

Deaconess Illinois Specialty Clinic, Inc. is located at 2700 W Deyoung St Ste F, Marion, IL 62959. The listed phone number is (618) 969-8633.

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

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

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, 3 practice at this address and 42 within 10 miles. 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 14D2146145) is associated with this NPI, valid through March 21, 2028. 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.