1. Home
  2. Directory
  3. Illinois
  4. Marion
  5. Family Medicine
  6. NPI Profile

DEACONESS IL CLINIC 17TH ST
NPI 1326765090
Family Medicine in Marion, IL

Active since October 24, 2022
2703 17TH ST APT D, MARION, IL 62959(618) 998-9200(618) 998-9700 Get Directions Write a Review

NPPES record last updated: February 2, 2023. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Feb 2, 2023, Jan 26, 2023, Dec 2, 2022 and 1 more (4 updates tracked since 2022).

About Deaconess Il Clinic 17th St NPPES

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

DEACONESS IL CLINIC 17TH ST (NPI 1326765090) is a healthcare organization registered as a family medicine in Marion, Illinois and active in the NPI registry since October 2022. The organization lists Kyle Dillman, Secretary / Treasurer, as its authorized official.

NPPES Registry Identity

NPI1326765090
Entity TypeOrganization
Primary Taxonomy207Q00000X
Legal Business NameDEACONESS ILLINOIS CLINIC, INC
Location Address2703 17TH ST APT DMarion, IL 62959-4912
Mailing AddressPo Box 34156Belfast, ME 04915-0619 · (812) 450-6815 · Fax (812) 450-6822
Phone(618) 998-9200
Fax(618) 998-9700
Organization SubpartNo
Authorized OfficialKyle DillmanSecretary / Treasurer · (812) 450-7399
Enumeration DateOctober 24, 2022
Last NPPES UpdateFebruary 2, 20234 updates tracked since enumeration
NPPES CertifiedFebruary 2, 2023
✔ NPI 1326765090 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
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.
Also ListedNurse PractitionerTaxonomy 363L00000X
2703 17TH ST APT D, Marion, IL 62959
Open in Google Maps ↗

Other Names 1

Doing Business AsDeaconess Il Clinic 17th St

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

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Deaconess Il Clinic 17th St is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

29

Medicare enrollment records show 29 clinicians reassign Medicare billing to Deaconess Il Clinic 17th St, which bills Medicare for the services they deliver. Of these, 10 practice within 10 miles. Listed here are the 20 practicing nearest to this location.

Clinicians by Medicare Specialty 5

Nurse Practitioner18
Family Practice8
Emergency Medicine1
Geriatric Medicine1
Pediatric Medicine1

Nearest to this location (20)

See all 29
Kara Tipsword, FNP-C
Nurse Practitioner
NPI 1689363509
2700 W DEYOUNG ST STE F
Marion, IL 62959
(618) 969-8633
✔ PECOS✔ Accepts Medicare0.1 mi
Elizabeth Eversmann, FNP-C
Nurse Practitioner
NPI 1528051182
3106 OUTER DR
Marion, IL 62959
(618) 997-4332
✔ PECOS0.9 mi
Dietra Angelly, FNP-C
Nurse Practitioner
NPI 1902371313
3411 PROFESSIONAL PARK DR
Marion, IL 62959
(618) 969-8630
✔ PECOS✔ Accepts Medicare1.6 mi
Robin Dailey
Nurse Practitioner
NPI 1265893051
3411 PROFESSIONAL PARK DR
Marion, IL 62959
(618) 997-2161
✔ PECOS✔ Accepts Medicare1.6 mi
Kalinda Dunning
Nurse Practitioner
NPI 1851961635
3411 PROFESSIONAL PARK DR
Marion, IL 62959
(618) 969-8630
✔ PECOS✔ Accepts Medicare1.6 mi
Jodi Fox, M.D.
Family Practice
NPI 1508848284
3411 PROFESSIONAL PARK DR
Marion, IL 62959
(618) 997-2161
✔ PECOS✔ Accepts Medicare1.6 mi
Nicole Kennedy, MD
Family Practice
NPI 1780902486
3411 PROFESSIONAL PARK DRIVE SIMCA
Marion, IL 62959
(618) 997-2161
✔ PECOS✔ Accepts Medicare1.6 mi
Lindsey Sollers
Nurse Practitioner
NPI 1124797535
3411 PROFESSIONAL PARK DR
Marion, IL 62959
(618) 997-2161
✔ PECOS✔ Accepts Medicare1.6 mi
Maryanne Flint, FNP
Nurse Practitioner
NPI 1992343248
3408 OFFICE PARK DR
Marion, IL 62959
(618) 997-5266
✔ PECOS✔ Accepts Medicare1.7 mi
Ma Claravel Criste, M.D.
Pediatric Medicine
NPI 1245486679
2102 WINDSOR DR
Marion, IL 62959
(618) 364-0348
✔ PECOS2.2 mi
Suzanne Burge, MD
Family Practice
NPI 1467456798
1564 S WASHINGTON ST
Du Quoin, IL 62832
(618) 542-8702
✔ PECOS✔ Accepts Medicare22 mi
Diana Vaughn, FNP-C
Nurse Practitioner
NPI 1588185888
117 E CLARK ST
Harrisburg, IL 62946
(618) 252-8625
✔ PECOS✔ Accepts Medicare24 mi
Melissa Odle, FNP
Nurse Practitioner
NPI 1225308406
6294 STATE HIGHWAY 154
Sesser, IL 62884
(618) 625-6979
✔ PECOS✔ Accepts Medicare24 mi
Adam Henson
Family Practice
NPI 1154684975
916 N WASHINGTON STREET
Du Quoin, IL 62832
(618) 790-7401
✔ PECOS✔ Accepts Medicare24 mi
Rachel Bailey, APRN
Nurse Practitioner
NPI 1427511757
6695 HWY 146 E
Vienna, IL 62995
(618) 658-8371
✔ PECOS26 mi
Bayly Adams, APRN
Nurse Practitioner
NPI 1295443653
4101 N WATER TOWER PL
Mount Vernon, IL 62864
(618) 244-6222
✔ PECOS✔ Accepts Medicare39 mi
Dennon Davis, M.D.
Family Practice
NPI 1689788630
4105 N WATER TOWER PL
Mount Vernon, IL 62864
(618) 244-9495
✔ PECOS✔ Accepts Medicare39 mi
Julie Kelley, MD
Emergency Medicine
NPI 1306980552
325 SPRING ST
Red Bud, IL 62278
(618) 282-3831
✔ PECOS✔ Accepts Medicare65 mi
Amy Rohlfing, MD
Geriatric Medicine
NPI 1255335188
325 SPRING ST
Red Bud, IL 62278
(618) 282-7373
✔ PECOS✔ Accepts Medicare65 mi
Rosanne Sutter, MD
Family Practice
NPI 1154422673
211 S 3RD ST
Belleville, IL 62220
(618) 234-2120
✔ PECOS✔ Accepts Medicare77 mi
See all 29 clinicians

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

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 14D1090373

Deaconess Illinois Clinic · Marion, IL
Expired · Oct 8, 2026
CLIA Number14D1090373
Laboratory TypePhysician Office
Certificate Effective DateOctober 9, 2024
Certificate Expiration DateOctober 8, 2026
Laboratory DirectorEric Graham
Laboratory Phone(618) 998-9200
Laboratory LocationDeaconess Illinois Clinic2703 17th St - Ste D, Marion, IL 62959
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

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 Deaconess Illinois Clinic, Inc's NPI number?

The NPI number for Deaconess Illinois Clinic, Inc is 1326765090. It was assigned to this organization in the NPPES registry on October 24, 2022. The provider is doing business as Deaconess Il Clinic 17th St.

Where is Deaconess Illinois Clinic, Inc located?

Deaconess Illinois Clinic, Inc is located at 2703 17th St Apt D, Marion, IL 62959. The listed phone number is (618) 998-9200.

What is Deaconess Illinois Clinic, Inc's specialty?

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

Is Deaconess Illinois Clinic, Inc enrolled in Medicare?

Yes. Deaconess Illinois Clinic, Inc is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Deaconess Illinois Clinic, Inc?

According to the CMS Revalidation Reassignment List (October 2026 release), 29 clinicians in 5 Medicare specialties reassign their Medicare billing to Deaconess Illinois Clinic, Inc. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. The largest specialties are Nurse Practitioner (18), Family Practice (8) and Emergency Medicine (1). Of these, 10 practice within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

When was this NPI record last updated?

The NPPES record for Deaconess Illinois Clinic, Inc was last updated on February 2, 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.