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PERFORMANCE MEDICAL CLINIC LLC
NPI 1255746715
Internal Medicine in Fairview Heights, IL

Active since June 24, 2014CLIA 14D2103719 · Waiver
5036 N ILLINOIS ST, SUITE 1, FAIRVIEW HEIGHTS, IL 62208(618) 671-6800(619) 671-6604 Get Directions Write a Review

NPPES record last updated: July 18, 2018. Verified against the NPPES registry weekly; last sync: August 23, 2026.

About Performance Medical Clinic Llc NPPES

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

PERFORMANCE MEDICAL CLINIC LLC (NPI 1255746715) is a healthcare organization registered as an internal medicine in Fairview Heights, Illinois and active in the NPI registry since June 2014. The organization holds a CLIA Waiver certificate valid through October 19, 2027 and lists Michael Thomas Ambrose, Owner/ceo, as its authorized official.

NPPES Registry Identity

NPI1255746715
Entity TypeOrganization
Primary Taxonomy207R00000X
Legal Business NameCENTER FOR ADVANCED MEDICINE LLC
Location Address5036 N ILLINOIS ST, SUITE 1Fairview Heights, IL 62208
Mailing Address5036 N Illinois St, Ste 1Fairview Heights, IL 62208-3411 · (618) 671-6800 · Fax (618) 671-6604
Phone(618) 671-6800
Fax(619) 671-6604
Organization SubpartNo
Authorized OfficialMichael Thomas AmbroseOwner/ceo · (618) 420-9360
Enumeration DateJune 24, 2014
Last NPPES UpdateJuly 18, 2018
✔ NPI 1255746715 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.
5036 N ILLINOIS ST, Fairview Heights, IL 62208
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Other Names 1

Doing Business AsPerformance Medical Clinic Llc

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 14D2103719

Performance Medical Clinic LLC Ambrose Medical LLC · Edwardsville, IL
Active · expires Oct 19, 2027
CLIA Number14D2103719
Laboratory TypePhysician Office
Certificate Effective DateOctober 20, 2025
Certificate Expiration DateOctober 19, 2027
Laboratory DirectorMichael T. Ambrose MD
Laboratory Phone(618) 671-6800
Laboratory LocationPerformance Medical Clinic LLC Ambrose Medical LLC1181 State Route 157 - Ste 100B, Edwardsville, IL 62025
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES

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

ALI ALBERS FNP
Nurse Practitioner (Family)
5036 N ILLINOIS ST
FAIRVIEW HEIGHTS, IL 62208
St. Clair County (618) 671-6800

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 Center For Advanced Medicine LLC's NPI number?

The NPI number for Center For Advanced Medicine LLC is 1255746715. It was assigned to this organization in the NPPES registry on June 24, 2014. The provider is doing business as Performance Medical Clinic LLC.

Where is Center For Advanced Medicine LLC located?

Center For Advanced Medicine LLC is located at 5036 N Illinois St Suite 1, Fairview Heights, IL 62208. The listed phone number is (618) 671-6800.

What is Center For Advanced Medicine LLC's specialty?

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

Does Center For Advanced Medicine LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 14D2103719) is associated with this NPI, valid through October 19, 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 Center For Advanced Medicine LLC was last updated on July 18, 2018. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 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.