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CENTRAL ILLINOIS PREVENTIVE SERVICES LLC
NPI 1144003633
Family Medicine in Bloomington, IL

Active since August 17, 2023CLIA 14D2294500 · Waiver
1603 TULLAMORE AVE STE A, BLOOMINGTON, IL 61704(309) 808-6407 Get Directions Write a Review

NPPES record last updated: August 17, 2023. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Central Illinois Preventive Services Llc NPPES

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

CENTRAL ILLINOIS PREVENTIVE SERVICES LLC (NPI 1144003633) is a healthcare organization registered as a family medicine in Bloomington, Illinois and active in the NPI registry since August 2023. The organization holds a CLIA Waiver certificate valid through November 27, 2027 and lists Larry Overcash, Owner, as its authorized official.

NPPES Registry Identity

NPI1144003633
Entity TypeOrganization
Primary Taxonomy207Q00000X
Legal Business NameCENTRAL ILLINOIS PREVENTIVE SERVICES LLC
Location Address1603 TULLAMORE AVE STE ABloomington, IL 61704-9623
Mailing Address1603 Tullamore Ave Ste ABloomington, IL 61704-9623
Phone(309) 808-6407
Organization SubpartYes
Authorized OfficialLarry OvercashOwner · (309) 696-9010
Enumeration DateAugust 17, 2023
NPPES CertifiedAugust 17, 2023
✔ NPI 1144003633 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ 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.
1603 TULLAMORE AVE STE A, Bloomington, IL 61704
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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

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 14D2294500

Central Illinois Preventive Services · Bloomington, IL
Active · expires Nov 27, 2027
CLIA Number14D2294500
Laboratory TypePhysician Office
Certificate Effective DateNovember 28, 2025
Certificate Expiration DateNovember 27, 2027
Laboratory DirectorLarry Overcash
Laboratory Phone(309) 808-6407
Laboratory LocationCentral Illinois Preventive Services1603 Tullamore Ave - Unit A, Bloomington, IL 61704
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 2

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

JENI LYNN ZOLFAGHARI APN, CNP
Nurse Practitioner
1603 TULLAMORE AVE STE A
BLOOMINGTON, IL 61704
McLean County (309) 808-6407
KAITLYN HEFFREN FNP-C
Nurse Practitioner (Family)
1603 TULLAMORE AVE STE A
BLOOMINGTON, IL 61704
McLean County (309) 808-6407

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 Central Illinois Preventive Services LLC's NPI number?

The NPI number for Central Illinois Preventive Services LLC is 1144003633. It was assigned to this organization in the NPPES registry on August 17, 2023.

Where is Central Illinois Preventive Services LLC located?

Central Illinois Preventive Services LLC is located at 1603 Tullamore Ave Ste A, Bloomington, IL 61704. The listed phone number is (309) 808-6407.

What is Central Illinois Preventive Services LLC's specialty?

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

Does Central Illinois Preventive Services LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 14D2294500) is associated with this NPI, valid through November 27, 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 Central Illinois Preventive Services LLC was last updated on August 17, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 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.