DEACONESS IL SPECIALTY BAILEY LN
NPI 1629785183
Orthopaedic Surgery in Benton, IL

Active since November 03, 2022CLIA Certified · 2 labs
205 BAILEY LN STE F, BENTON, IL 62812(618) 882-4200(618) 882-4208 Get Directions Write a Review

NPPES record last updated: January 26, 2023. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: Jan 26, 2023, Dec 2, 2022, Nov 9, 2022 and 1 more (4 updates tracked since 2022).

About Deaconess Il Specialty Bailey Ln NPPES

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

DEACONESS IL SPECIALTY BAILEY LN (NPI 1629785183) is a healthcare organization registered as an orthopaedic surgery in Benton, Illinois and active in the NPI registry since November 2022. The organization holds 2 active CLIA laboratory certificates and lists Kyle Dillman, Secretary Treasurer, as its authorized official.

NPPES Registry Identity

NPI1629785183
Entity TypeOrganization
Primary Taxonomy207X00000X
Legal Business NameDEACONESS ILLINOIS SPECIALTY CLINIC, INC.
Location Address205 BAILEY LN STE FBenton, IL 62812-1921
Mailing AddressPo Box 34266Belfast, ME 04915-0620 · (812) 450-6815 · Fax (812) 450-6822
Fax(618) 882-4208
Organization SubpartNo
Authorized OfficialKyle DillmanSecretary Treasurer · (812) 450-7399
Enumeration DateNovember 3, 2022
Last NPPES UpdateJanuary 26, 20234 updates tracked since enumeration
NPPES CertifiedJanuary 26, 2023
NPI 1629785183 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 4

Primary SpecialtyOrthopaedic SurgeryAllopathic & Osteopathic Physicians
Taxonomy Code207X00000X
Definition

An orthopaedic surgeon is trained in the preservation, investigation and restoration of the form and function of the extremities, spine and associated structures by medical, surgical and physical means. An orthopaedic surgeon is involved with the care of patients whose musculoskeletal problems include congenital deformities, trauma, infections, tumors, metabolic disturbances of the musculoskeletal system, deformities, injuries and degenerative diseases of the spine, hands, feet, knee, hip, shoulder and elbow in children and adults. An orthopaedic surgeon is also concerned with primary and secondary muscular problems and the effects of central or peripheral nervous system lesions of the musculoskeletal system.

Also ListedInternal Medicine · GastroenterologyTaxonomy 207RG0100X
Also ListedSurgeryTaxonomy 208600000X
Also ListedNurse PractitionerTaxonomy 363L00000X
205 BAILEY LN STE F, Benton, IL 62812

Other Names 1

Doing Business AsDeaconess Il Specialty Bailey Ln

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 2

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 14D2331517

Deaconess Illinois Sprecialty Clinic · Benton, IL
Active · expires Oct 2, 2027
CLIA Number14D2331517
Laboratory TypePhysician Office
Certificate Effective DateOctober 3, 2025
Certificate Expiration DateOctober 2, 2027
Laboratory DirectorMack Mccain
Laboratory Phone(618) 882-4200
Laboratory LocationDeaconess Illinois Sprecialty Clinic205 Bailey Ln - Ste F, Benton, IL 62812
CLIA data matches this NPI record on: Address Phone
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 14D2266989

Deaconess Illinois Clinic · Benton, IL
Active · expires Aug 17, 2026
CLIA Number14D2266989
Laboratory TypePhysician Office
Certificate Effective DateAugust 18, 2024
Certificate Expiration DateAugust 17, 2026
Laboratory DirectorEric Graham
Laboratory Phone(618) 882-4200
Laboratory LocationDeaconess Illinois Clinic205 Bailey Lane - Ste F, Benton, IL 62812
CLIA data matches this NPI record on: Address Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 3

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

Clinic/Center (Rural Health)
205 BAILEY LN STE F
BENTON, IL 62812
Clinic/Center (Rural Health)
205 BAILEY LN STE F
BENTON, IL 62812
Family Medicine
205 BAILEY LN STE F
BENTON, IL 62812

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 Specialty Clinic, Inc.'s NPI number?

The NPI number for Deaconess Illinois Specialty Clinic, Inc. is 1629785183. It was assigned to this organization in the NPPES registry on November 3, 2022. The provider is doing business as Deaconess Il Specialty Bailey Ln.

Where is Deaconess Illinois Specialty Clinic, Inc. located?

Deaconess Illinois Specialty Clinic, Inc. is located at 205 Bailey Ln Ste F, Benton, IL 62812. The listed phone number is (618) 882-4200.

What is Deaconess Illinois Specialty Clinic, Inc.'s specialty?

The primary specialty registered for this NPI is Orthopaedic Surgery with taxonomy code 207X00000X.

Does Deaconess Illinois Specialty Clinic, Inc. hold CLIA laboratory certificates?

Yes. 2 active CLIA laboratory certificates are associated with this NPI under the federal Clinical Laboratory Improvement Amendments program. The certificates are listed in the CLIA Laboratory Certificates section above.

When was this NPI record last updated?

The NPPES record for Deaconess Illinois Specialty Clinic, Inc. was last updated on January 26, 2023. NPI Profile syncs with the weekly NPPES data releases published by CMS.