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DEACONESS ILLINOIS CLINIC
NPI 1366169997
Family Medicine in Anna, IL

Active since October 25, 2022CLIA 14D0436483 · Accreditation
515 N MAIN ST, ANNA, IL 62906(618) 833-4511(618) 833-2414 Get Directions Write a Review

NPPES record last updated: December 2, 2022. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: Dec 2, 2022, Oct 25, 2022 (2 updates tracked since 2022).

About Deaconess Illinois Clinic NPPES

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

DEACONESS ILLINOIS CLINIC (NPI 1366169997) is a healthcare organization registered as a family medicine in Anna, Illinois and active in the NPI registry since October 2022. The organization holds an CLIA Accreditation certificate valid through August 16, 2027 and lists Kyle Dillman, Secretary / Treasurer, as its authorized official.

NPPES Registry Identity

NPI1366169997
Entity TypeOrganization
Primary Taxonomy207Q00000X
Legal Business NameDEACONESS ILLINOIS CLINIC, INC
Location Address515 N MAIN STAnna, IL 62906-1668
Mailing AddressPo Box 34156Belfast, ME 04915-0619 · (812) 450-6815 · Fax (812) 450-6822
Phone(618) 833-4511
Fax(618) 833-2414
Organization SubpartNo
Authorized OfficialKyle DillmanSecretary / Treasurer · (812) 450-7399
Enumeration DateOctober 25, 2022
Last NPPES UpdateDecember 2, 20222 updates tracked since enumeration
NPPES CertifiedDecember 2, 2022
✔ NPI 1366169997 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ 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 ListedSurgeryTaxonomy 208600000X
Also ListedNurse PractitionerTaxonomy 363L00000X
515 N MAIN ST, Anna, IL 62906
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Other Names 1

Doing Business AsDeaconess Illinois Clinic

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 Accreditation 14D0436483

Deaconess Illinois Untion County · Anna, IL
Active · expires Aug 16, 2027
CLIA Number14D0436483
Laboratory TypeHospital
Certificate Effective DateAugust 17, 2025
Certificate Expiration DateAugust 16, 2027
Laboratory DirectorBridget Herschap
Laboratory Phone(618) 833-4511
Laboratory LocationDeaconess Illinois Untion County517 N Main St, Anna, IL 62906
CLIA data matches this NPI record on: Phone
This is a certificate that is issued to a laboratory on the basis of the laboratory's accreditation by an accreditation organization approved by CMS.

Other Providers at the Same Location NPPES 5

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

UNION COUNTY HOSPITAL DISTRICT
Surgery
515 N MAIN ST
ANNA, IL 62906
Union County (618) 833-2872
ANNA CLINIC CORP
Durable Medical Equipment & Medical Supplies
515 N MAIN ST, SUITE E
ANNA, IL 62906
Union County (618) 833-2872
DR. JOHN MICHAEL CERNY M.D.
Family Medicine
515 N MAIN ST
ANNA, IL 62906
Union County (618) 833-3300
ANNA CLINIC CORP
Family Medicine
515 N MAIN ST, SUITE C
ANNA, IL 62906
Union County (618) 833-2872
ANNA CLINIC CORP
Surgery
515 N MAIN ST, SUITE D
ANNA, IL 62906
Union County (618) 833-2872

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 1366169997. It was assigned to this organization in the NPPES registry on October 25, 2022. The provider is doing business as Deaconess Illinois Clinic.

Where is Deaconess Illinois Clinic, Inc located?

Deaconess Illinois Clinic, Inc is located at 515 N Main St, Anna, IL 62906. The listed phone number is (618) 833-4511.

What is Deaconess Illinois Clinic, Inc's specialty?

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

Does Deaconess Illinois Clinic, Inc hold a CLIA laboratory certificate?

Yes. A Certificate of Accreditation (number 14D0436483) is associated with this NPI, valid through August 16, 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 Deaconess Illinois Clinic, Inc was last updated on December 2, 2022. NPI Profile syncs with the weekly NPPES data releases published by CMS.