THE SPORTS & PHYSICAL MEDICINE CLINIC @ ST. MARY'S
NPI 1174702708
Physician Assistant in Decatur, IL

Q: What is St Marys Hospital Decatur Of The Hospital Sisters Of The Third Order's specialty?

The primary specialty registered for this NPI is Physician Assistant with taxonomy code 363A00000X.

Active since October 31, 2007

1900 E LAKE SHORE DR, SUITE 200, DECATUR, IL 62521(217) 464-1030(217) 464-1039 Get Directions Write a Review

NPPES record last updated: October 31, 2024. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: Dec 12, 2022, Dec 22, 2021 (2 updates tracked since 2021).

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About The Sports & Physical Medicine Clinic @ St. Mary's NPPES

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

THE SPORTS & PHYSICAL MEDICINE CLINIC @ ST. MARY'S (NPI 1174702708) is a healthcare organization registered as a physician assistant in Decatur, Illinois and active in the NPI registry since October 2007. The organization lists Mark D Evard, Vp Of Revenue Cycle, as its authorized official.

NPPES Registry Identity

NPI1174702708

Entity TypeOrganization

Primary Taxonomy363A00000X

Legal Business NameST MARYS HOSPITAL DECATUR OF THE HOSPITAL SISTERS OF THE THIRD ORDER

Location Address1900 E LAKE SHORE DR, SUITE 200Decatur, IL 62521-3824

Mailing Address3051 Hollis DrSpringfield, IL 62704-7450 · (217) 464-2966 · Fax (217) 464-1039

Phone(217) 464-1030

Fax(217) 464-1039

Organization SubpartNo

Authorized OfficialMark D EvardVp Of Revenue Cycle · (217) 492-9651

Enumeration DateOctober 31, 2007

Last NPPES UpdateOctober 31, 20242 updates tracked since enumeration

NPPES CertifiedOctober 31, 2024

✔ NPI 1174702708 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician AssistantPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363A00000X

License✔ Licensed in IL · 085-003034

Definition

A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.

1900 E LAKE SHORE DR, Decatur, IL 62521

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Other Names 1

Doing Business AsThe Sports & Physical Medicine Clinic @ St. Mary's

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

Other Providers at the Same Location NPPES 15

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

MRS. PAMELA MUELLER P.T.A.

Physical Therapy Assistant

1900 E LAKE SHORE DR
DECATUR, IL 62521

Macon County (217) 428-6222

DAVID L HOLTZSCHER ATC

Specialist/Technologist (Athletic Trainer)

1900 E LAKE SHORE DR, SUITE 150
DECATUR, IL 62521

Macon County (217) 428-6222

SPORTS MEDICINE CLINIC OF MACON COUNTY

Physical Therapist

1900 E LAKE SHORE DR, SUITE 150
DECATUR, IL 62521

Macon County (217) 428-6222

CRYSTAL LOUISE ZEIGLER ATC

Specialist/Technologist (Athletic Trainer)

1900 E LAKE SHORE DR
DECATUR, IL 62521

Macon County (217) 464-5970

MRS. LINDA S PIETRZAK NP

Nurse Practitioner (Pediatrics)

1900 E LAKE SHORE DR, SUITE 330
DECATUR, IL 62521

Macon County (217) 423-2889

MRS. JENNIFER JOHNSTON PT, CERT. MDT

Physical Therapist

1900 E LAKE SHORE DR
DECATUR, IL 62521

Macon County (217) 428-6222

MRS. KAREN HILL PT, CERT. MDT

Physical Therapist

1900 E LAKE SHORE DR, SUITE 150
DECATUR, IL 62521

Macon County (217) 428-6222

MISS ANGELA DURFEY MS, ATC, L

Specialist/Technologist (Athletic Trainer)

1900 E LAKE SHORE DR
DECATUR, IL 62521

Macon County (217) 428-6222

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 St Marys Hospital Decatur Of The Hospital Sisters Of The Third Order's NPI number?

The NPI number for St Marys Hospital Decatur Of The Hospital Sisters Of The Third Order is 1174702708. It was assigned to this organization in the NPPES registry on October 31, 2007. The provider is doing business as The Sports & Physical Medicine Clinic @ St. Mary's.

Where is St Marys Hospital Decatur Of The Hospital Sisters Of The Third Order located?

St Marys Hospital Decatur Of The Hospital Sisters Of The Third Order is located at 1900 E Lake Shore Dr Suite 200, Decatur, IL 62521. The listed phone number is (217) 464-1030.

What is St Marys Hospital Decatur Of The Hospital Sisters Of The Third Order's specialty?

The primary specialty registered for this NPI is Physician Assistant with taxonomy code 363A00000X.

When was this NPI record last updated?

The NPPES record for St Marys Hospital Decatur Of The Hospital Sisters Of The Third Order was last updated on October 31, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 21 months 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.