DEACONESS IL SPECIALTY HAMACHER ST
NPI 1336856806
Internal Medicine - Interventional Cardiology in Waterloo, IL
About Deaconess Il Specialty Hamacher St NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
DEACONESS IL SPECIALTY HAMACHER ST (NPI 1336856806) is a healthcare organization registered as an interventional cardiology in Waterloo, Illinois and active in the NPI registry since November 2022. The organization holds a CLIA Waiver certificate valid through February 15, 2028 and lists Kyle Dillman, Secretary Treasurer, as its authorized official.
NPPES Registry Identity
Specialties & Licenses 4
Other Names 2
Group Practice 1
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 Specialty Hamacher St is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
227Medicare enrollment records show 227 clinicians reassign Medicare billing to Deaconess Il Specialty Hamacher St, which bills Medicare for the services they deliver. Of these, 2 practice at this address and 3 within 10 miles. Listed here are the 20 practicing nearest to this location.
Clinicians by Medicare Specialty 29
Nearest to this location (20)
See all 227Source: 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 14D0434529
Deaconess Illinois Clinic · Waterloo, ILFrequently 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 Specialty Clinic, Inc.'s NPI number?
The NPI number for Deaconess Illinois Specialty Clinic, Inc. is 1336856806. It was assigned to this organization in the NPPES registry on November 3, 2022. The provider is doing business as Deaconess Il Specialty Hamacher St and St. Louis Cardiovascular.
Where is Deaconess Illinois Specialty Clinic, Inc. located?
Deaconess Illinois Specialty Clinic, Inc. is located at 509 Hamacher St, Waterloo, IL 62298. The listed phone number is (618) 939-4200.
What is Deaconess Illinois Specialty Clinic, Inc.'s specialty?
The primary specialty registered for this NPI is Internal Medicine, specializing in Interventional Cardiology, with taxonomy code 207RI0011X.
Is Deaconess Illinois Specialty Clinic, Inc. enrolled in Medicare?
Yes. Deaconess Illinois Specialty Clinic, Inc. is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Deaconess Illinois Specialty Clinic, Inc.?
According to the CMS Revalidation Reassignment List (October 2026 release), 227 clinicians in 29 Medicare specialties reassign their Medicare billing to Deaconess Illinois Specialty 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 (56), Family Practice (26) and Internal Medicine (24). Of these, 2 practice at this address and 3 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Does Deaconess Illinois Specialty Clinic, Inc. hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 14D0434529) is associated with this NPI, valid through February 15, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
When was this NPI record last updated?
The NPPES record for Deaconess Illinois Specialty Clinic, Inc. was last updated on June 7, 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.
# Deaconess Il Specialty Hamacher St · NPI 1336856806
Interventional Cardiology organization in Waterloo, Illinois. Organization record, active in the CMS NPPES registry since November 3, 2022.
## Identity
- **NPI:** 1336856806 (Entity type: Organization)
- **Enumerated:** November 3, 2022
- **Primary specialty:** Internal Medicine - Interventional Cardiology · taxonomy 207RI0011X
- **Legal business name:** Deaconess Illinois Specialty Clinic, Inc.
- **Also known as:** St. Louis Cardiovascular (Doing Business As)
- **Organization subpart:** No
- **Authorized official:** Kyle Dillman, SECRETARY TREASURER
## Practice location
- **Address:** 509 HAMACHER ST, Waterloo, IL 62298-1592
- **Phone:** (618) 939-4200 · **Fax:** (618) 939-4256
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 227 clinicians in 29 Medicare specialties reassign Medicare billing to this organization (form CMS-855R); largest: Nurse Practitioner (56), Family Practice (26), Internal Medicine (24); 2 practice at this address and 3 within 10 miles; [full list](https://npiprofile.com/npi/1336856806/clinicians) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** June 7, 2023
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1336856806) · Data from the CMS NPPES public registry.