1. Home
  2. Directory
  3. Illinois
  4. Decatur
  5. Internal Medicine
  6. NPI Profile

MILLIKIN UNIVERSITY
NPI 1164176863
Internal Medicine in Decatur, IL

Active since February 10, 2022CLIA 14D2322108 · Waiver
1184 W MAIN ST, DECATUR, IL 62522(972) 367-4845 Get Directions Write a Review

NPPES record last updated: February 10, 2022. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Millikin University NPPES

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

MILLIKIN UNIVERSITY (NPI 1164176863), doing business as Millikin University Athletics, is a healthcare organization registered as an internal medicine in Decatur, Illinois and active in the NPI registry since February 2022. The organization holds a CLIA Waiver certificate valid through April 14, 2027 and lists Mouzon Bass, Administrator/agent, as its authorized official.

NPPES Registry Identity

NPI1164176863
Entity TypeOrganization
Primary Taxonomy207R00000X
Legal Business NameMILLIKIN UNIVERSITY
Location Address1184 W MAIN STDecatur, IL 62522-2039
Mailing Address15305 Dallas Pkwy Ste 800Addison, TX 75001-6415 · (972) 367-4845 · Fax (972) 367-3451
Phone(972) 367-4845
Organization SubpartNo
Authorized OfficialMouzon BassAdministrator/agent · (972) 367-4845
Enumeration DateFebruary 10, 2022
NPPES CertifiedFebruary 10, 2022
✔ NPI 1164176863 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyInternal MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207R00000X
Definition
A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.
1184 W MAIN ST, Decatur, IL 62522
Open in Google Maps ↗

Other Names 1

Doing Business AsMillikin University Athletics

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 14D2322108

Millikin University Health Clinic · Decatur, IL
Active · expires Apr 14, 2027
CLIA Number14D2322108
Laboratory TypeSchool/Student Health Service
Certificate Effective DateApril 15, 2025
Certificate Expiration DateApril 14, 2027
Laboratory DirectorKelly Slade
Laboratory Phone(217) 424-6360
Laboratory LocationMillikin University Health Clinic150 S Fairview Ave, Decatur, IL 62522
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 3

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

JOHN RICHARD STORSVED II H.S.D. ATC
Specialist/Technologist (Athletic Trainer)
1184 W MAIN ST
DECATUR, IL 62522
Macon County (217) 424-6364
CHRISTOPHER DANBURY
Contractor
1184 W MAIN ST, GRISWOLD PHYSICAL EDUCATION CENTER
DECATUR, IL 62522
Macon County (845) 988-6028
BEN CLAWSON ATC, CSCS
Specialist/Technologist (Athletic Trainer)
1184 W MAIN ST
DECATUR, IL 62522
Macon County (217) 424-3955

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 Millikin University's NPI number?

The NPI number for Millikin University is 1164176863. It was assigned to this organization in the NPPES registry on February 10, 2022. The provider is doing business as Millikin University Athletics.

Where is Millikin University located?

Millikin University is located at 1184 W Main St, Decatur, IL 62522. The listed phone number is (972) 367-4845.

What is Millikin University's specialty?

The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.

Does Millikin University hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 14D2322108) is associated with this NPI, valid through April 14, 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 Millikin University was last updated on February 10, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 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.