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OPTIMAL HEALTH MEDICINE LLC
NPI 1316299332
Family Medicine in Godfrey, IL

Active since October 15, 2012CLIA 14D2052539 · Waiver
1368 DADRIAN PROFESSIONAL PARK, GODFREY, IL 62035(618) 433-9701(618) 433-9706 Get Directions Write a Review

NPPES record last updated: May 14, 2025. Verified against the NPPES registry weekly; last sync: August 23, 2026.

About Optimal Health Medicine Llc NPPES

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

OPTIMAL HEALTH MEDICINE LLC (NPI 1316299332) is a healthcare organization registered as a family medicine in Godfrey, Illinois and active in the NPI registry since October 2012. The organization holds a CLIA Waiver certificate valid through January 10, 2027 and lists Jon Anthony Wagnon, President, as its authorized official.

NPPES Registry Identity

NPI1316299332
Entity TypeOrganization
Primary Taxonomy207Q00000X
Legal Business NameOPTIMAL HEALTH MEDICINE LLC
Location Address1368 DADRIAN PROFESSIONAL PARKGodfrey, IL 62035-1685
Mailing Address1368 Dadrian Professional ParkGodfrey, IL 62035-1685 · (618) 433-9701 · Fax (618) 433-9706
Phone(618) 433-9701
Fax(618) 433-9706
Organization SubpartNo
Authorized OfficialJon Anthony WagnonPresident · (618) 433-9701
Enumeration DateOctober 15, 2012
Last NPPES UpdateMay 14, 2025
NPPES CertifiedMay 14, 2025
✔ NPI 1316299332 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
License✔ Licensed in IL · 036120316
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.
1368 DADRIAN PROFESSIONAL PARK, Godfrey, IL 62035
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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

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 14D2052539

Optimal Health Medicine · Godfrey, IL
Active · expires Jan 10, 2027
CLIA Number14D2052539
Laboratory TypePhysician Office
Certificate Effective DateJanuary 11, 2025
Certificate Expiration DateJanuary 10, 2027
Laboratory DirectorJon A. Wagnon
Laboratory Phone(618) 433-9701
Laboratory LocationOptimal Health Medicine1368 D'adrian Professional Park, Godfrey, IL 62035
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 2

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

DR. JON ANTHONY WAGNON D.O.
Emergency Medicine
1368 DADRIAN PROFESSIONAL PARK
GODFREY, IL 62035
Madison County (618) 433-9701
KELSEY WICKENHAUSER PA
Physician Assistant
1368 DADRIAN PROFESSIONAL PARK
GODFREY, IL 62035
Madison County (309) 530-9841

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 Optimal Health Medicine LLC's NPI number?

The NPI number for Optimal Health Medicine LLC is 1316299332. It was assigned to this organization in the NPPES registry on October 15, 2012.

Where is Optimal Health Medicine LLC located?

Optimal Health Medicine LLC is located at 1368 Dadrian Professional Park, Godfrey, IL 62035. The listed phone number is (618) 433-9701.

What is Optimal Health Medicine LLC's specialty?

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

Does Optimal Health Medicine LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 14D2052539) is associated with this NPI, valid through January 10, 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 Optimal Health Medicine LLC was last updated on May 14, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 15 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.