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WESTERN ILLINOIS MEDICAL GROUP, LLC
NPI 1205958741
Dermatology in Macomb, IL

Active since April 04, 2007CLIA 14D1012382 · Waiver
909 E GRANT ST, MACOMB, IL 61455(309) 837-7546(312) 674-7546 Get Directions Write a Review

NPPES record last updated: January 18, 2023. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: Jan 18, 2023, Aug 22, 2020 (2 updates tracked since 2020).

About Western Illinois Medical Group, Llc NPPES

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

WESTERN ILLINOIS MEDICAL GROUP, LLC (NPI 1205958741) is a healthcare organization registered as a dermatology in Macomb, Illinois and active in the NPI registry since April 2007. The organization holds a CLIA Waiver certificate valid through May 8, 2027 and lists Xiaolu Li, Physician, as its authorized official.

NPPES Registry Identity

NPI1205958741
Entity TypeOrganization
Primary Taxonomy207N00000X
Legal Business NameWESTERN ILLINOIS MEDICAL GROUP, LLC
Location Address909 E GRANT STMacomb, IL 61455-3371
Mailing Address909 E Grant StMacomb, IL 61455-3371 · (309) 837-7546 · Fax (126) 747-5463
Phone(309) 837-7546
Fax(312) 674-7546
Organization SubpartNo
Authorized OfficialXiaolu LiPhysician · (309) 837-7546
Enumeration DateApril 4, 2007
Last NPPES UpdateJanuary 18, 20232 updates tracked since enumeration
NPPES CertifiedJanuary 18, 2023
✔ NPI 1205958741 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyDermatologyAllopathic & Osteopathic Physicians
Taxonomy Code207N00000X
Definition
A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging.
Also ListedFamily MedicineTaxonomy 207Q00000X · License 036099467 (IL)
909 E GRANT ST, Macomb, IL 61455
Open in Google Maps ↗

Other Identifiers 2

Medicaid039099467IL
Other05532018IL · Blue Cross Blue Sheild

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 14D1012382

Western Illinois Medical Group L L C · Macomb, IL
Active · expires May 8, 2027
CLIA Number14D1012382
Laboratory TypePhysician Office
Certificate Effective DateMay 9, 2025
Certificate Expiration DateMay 8, 2027
Laboratory DirectorXiaolu Li, M D
Laboratory Phone(309) 837-2000
Laboratory LocationWestern Illinois Medical Group L L C909 E Grant Street, Suite A, Macomb, IL 61455
CLIA data matches this NPI record on: Address Name
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.

DR. ZHONG YE M.D.
Dermatology
909 E GRANT ST
MACOMB, IL 61455
McDonough County (309) 837-7546
DR. XIAOLU (SHERRY) LI M.D.
Family Medicine
909 E GRANT ST
MACOMB, IL 61455
McDonough County (309) 837-2000

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 Western Illinois Medical Group, LLC's NPI number?

The NPI number for Western Illinois Medical Group, LLC is 1205958741. It was assigned to this organization in the NPPES registry on April 4, 2007.

Where is Western Illinois Medical Group, LLC located?

Western Illinois Medical Group, LLC is located at 909 E Grant St, Macomb, IL 61455. The listed phone number is (309) 837-7546.

What is Western Illinois Medical Group, LLC's specialty?

The primary specialty registered for this NPI is Dermatology with taxonomy code 207N00000X.

Does Western Illinois Medical Group, LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 14D1012382) is associated with this NPI, valid through May 8, 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 Western Illinois Medical Group, LLC was last updated on January 18, 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.