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SHAWNEE HEALTH SERVICE AND DEVELOPMENT CORP
NPI 1639295314
Clinic/Center - Federally Qualified Health Center (FQHC) in Carterville, IL

Active since March 22, 2007
109 CALIFORNIA ST, CARTERVILLE, IL 62918(618) 985-8221(618) 985-6860 Get Directions Write a Review

NPPES record last updated: April 5, 2024. Verified against the NPPES registry weekly; last sync: November 01, 2026.

Record update history: Apr 5, 2024, Dec 19, 2018, Dec 23, 2016 (3 updates tracked since 2016).

About Shawnee Health Service And Development Corp NPPES

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

SHAWNEE HEALTH SERVICE AND DEVELOPMENT CORP (NPI 1639295314) is a healthcare organization registered as a federally qualified health center (fqhc) in Carterville, Illinois and active in the NPI registry since March 2007. The organization lists Christina Carney, Ceo, as its authorized official.

NPPES Registry Identity

NPI1639295314
Entity TypeOrganization
Primary Taxonomy261QF0400X
Legal Business NameSHAWNEE HEALTH SERVICE AND DEVELOPMENT CORP
Location Address109 CALIFORNIA STCarterville, IL 62918-0577
Mailing Address109 California St, P O Box 577Carterville, IL 62918-0577 · (618) 985-8221 · Fax (618) 985-6860
Phone(618) 985-8221
Fax(618) 985-6860
Organization SubpartNo
Authorized OfficialChristina CarneyCeo · (618) 956-9521
Enumeration DateMarch 22, 2007
Last NPPES UpdateApril 5, 20243 updates tracked since enumeration
NPPES CertifiedApril 5, 2024
✔ NPI 1639295314 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 13

★ Primary SpecialtyClinic/Center · Federally Qualified Health Center (FQHC)Ambulatory Health Care Facilities
Taxonomy Code261QF0400X
Also ListedSocial Worker · ClinicalTaxonomy 1041C0700X
Also ListedDentistTaxonomy 122300000X
Also ListedDental HygienistTaxonomy 124Q00000X
Also ListedDental AssistantTaxonomy 126800000X
Also ListedDietitian, RegisteredTaxonomy 133V00000X
Also ListedFamily MedicineTaxonomy 207Q00000X
Also ListedFamily Medicine · Adolescent MedicineTaxonomy 207QA0000X
Also ListedInternal Medicine · Pulmonary DiseaseTaxonomy 207RP1001X
Also ListedObstetrics & GynecologyTaxonomy 207V00000X
Also ListedPediatricsTaxonomy 208000000X
Also ListedPsychiatry & Neurology · NeurologyTaxonomy 2084N0400X
Also ListedPharmacy · Community/Retail PharmacyTaxonomy 3336C0003X
109 CALIFORNIA ST, Carterville, IL 62918
Open in Google Maps ↗

Other Identifiers 9

Medicaid022IL
Medicaid020IL
Other640701Medicare Part B Group Id
Other10032052IL · Blue Cross Blue Shield
OtherCF3444IL · Medicare Railroad
Medicaid013IL
Medicaid024IL
Medicaid018IL
Medicaid019IL

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

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter Health, Ambetter Health of Delaware, UnitedHealthcare.Insurance ›

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Shawnee Health Service And Development Corp is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

52

Medicare enrollment records show 52 clinicians reassign Medicare billing to Shawnee Health Service And Development Corp, which bills Medicare for the services they deliver. Of these, 6 practice at this address and 40 within 10 miles. Listed here are the 20 practicing nearest to this location.

Clinicians by Medicare Specialty 8

Nurse Practitioner15
Family Practice8
Certified Nurse Midwife (CNM)7
Obstetrics/Gynecology7
Clinical Social Worker6
Mental Health Counselor5
Internal Medicine2
Registered Dietitian or Nutrition Professional2

Nearest to this location (20)

See all 52
Teresa Johnson, APRN
Nurse Practitioner
NPI 1639690191
1006 S DIVISION ST
Carterville, IL 62918
(618) 519-9200
✔ PECOS✔ Accepts MedicareSame address
Matin Nekzad, MD
Family Practice
NPI 1679548689
1006 S DIVISION ST
Carterville, IL 62918
(618) 985-4841
✔ PECOS✔ Accepts MedicareSame address
Katie Surman, RD
Registered Dietitian or Nutrition Professional
NPI 1033038005
1006 S DIVISION ST
Carterville, IL 62918
(618) 519-9200
✔ Accepts MedicareSame address
Kaif Mansuri, M.D.
Family Practice
NPI 1326429242
1006 S DIVISION ST
Carterville, IL 62918
(618) 519-9200
✔ PECOS✔ Accepts MedicareSame address
Amanda Reynolds, APN
Nurse Practitioner
NPI 1952785222
1006 S DIVISION ST
Carterville, IL 62918
(618) 519-9200
✔ PECOS✔ Accepts MedicareSame address
David Vaccaro, MSW, LCSW
Clinical Social Worker
NPI 1548852437
1006 S DIVISION ST
Carterville, IL 62918
(618) 519-9200
✔ PECOS✔ Accepts MedicareSame address
Ryan Rogulich, LCSW
Clinical Social Worker
NPI 1427713403
6355 BRANDHORST RD
Carterville, IL 62918
(618) 519-9200
✔ PECOS2.0 mi
Gaia Mcvey, LCPC
Mental Health Counselor
NPI 1740476910
1220 S PARK AVE
Herrin, IL 62948
(618) 988-1757
✔ PECOS✔ Accepts Medicare5.1 mi
Haley Brinkley, APRN
Nurse Practitioner
NPI 1962204933
3111 WILLIAMSON COUNTY PKWY
Marion, IL 62959
(618) 519-9200
✔ PECOS✔ Accepts Medicare5.3 mi
Lindsey Falmier, LCSW
Clinical Social Worker
NPI 1386356699
3111 WILLIAMSON COUNTY PKWY
Marion, IL 62959
(618) 519-9200
✔ PECOS✔ Accepts Medicare5.3 mi
Michael Parks, LCSW
Clinical Social Worker
NPI 1932818044
3111 WILLIAMSON COUNTY PKWY
Marion, IL 62959
(618) 519-9200
✔ PECOS✔ Accepts Medicare5.3 mi
Jill Piper, MS LCPC
Mental Health Counselor
NPI 1427164821
3111 WILLIAMSON COUNTY PKWY
Marion, IL 62959
(618) 519-9200
✔ PECOS5.3 mi
Liudmila Vasilets, MD
Internal Medicine
NPI 1225525579
3111 WILLIAMSON COUNTY PKWY
Marion, IL 62959
(618) 519-9200
✔ PECOS✔ Accepts Medicare5.3 mi
Renee Feather, MD
Family Practice
NPI 1528478559
400 S LEWIS LN
Carbondale, IL 62901
(618) 519-9200
✔ PECOS✔ Accepts Medicare7.0 mi
Tasmeer Hassan, MD
Family Practice
NPI 1801201538
400 S LEWIS LN
Carbondale, IL 62901
(618) 519-9200
✔ PECOS✔ Accepts Medicare7.0 mi
Mckenzie Bonifield
Nurse Practitioner
NPI 1205411204
400 S LEWIS LN
Carbondale, IL 62901
(618) 519-9200
✔ PECOS✔ Accepts Medicare7.0 mi
Anna Little, MD
Internal Medicine
NPI 1982801742
400 S LEWIS LN
Carbondale, IL 62901
(618) 519-9900
✔ PECOS✔ Accepts Medicare7.0 mi
Elizabeth Jolliff, CNM
Certified Nurse Midwife (CNM)
NPI 1366013013
101 S WALL ST
Carbondale, IL 62901
(618) 519-9200
✔ PECOS✔ Accepts Medicare7.4 mi
Erin Shaw, CNM
Certified Nurse Midwife (CNM)
NPI 1982498986
101 S WALL ST
Carbondale, IL 62901
(618) 519-9200
✔ PECOS✔ Accepts Medicare7.4 mi
Kenzie Glassburn, MD
Obstetrics/Gynecology
NPI 1467026195
101 S WALL ST
Carbondale, IL 62901
(618) 519-9200
✔ PECOS✔ Accepts Medicare7.5 mi
See all 52 clinicians

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

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 Shawnee Health Service And Development Corp's NPI number?

The NPI number for Shawnee Health Service And Development Corp is 1639295314. It was assigned to this organization in the NPPES registry on March 22, 2007.

Where is Shawnee Health Service And Development Corp located?

Shawnee Health Service And Development Corp is located at 109 California St, Carterville, IL 62918. The listed phone number is (618) 985-8221.

What is Shawnee Health Service And Development Corp's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Federally Qualified Health Center (FQHC), with taxonomy code 261QF0400X.

Is Shawnee Health Service And Development Corp enrolled in Medicare?

Yes. Shawnee Health Service And Development Corp is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Shawnee Health Service And Development Corp?

According to the CMS Revalidation Reassignment List (October 2026 release), 52 clinicians in 8 Medicare specialties reassign their Medicare billing to Shawnee Health Service And Development Corp. 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 (15), Family Practice (8) and Certified Nurse Midwife (CNM) (7). Of these, 6 practice at this address and 40 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

What insurance does Shawnee Health Service And Development Corp accept?

Health plans from Ambetter Health, Ambetter Health of Delaware and UnitedHealthcare list Shawnee Health Service And Development Corp as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Shawnee Health Service And Development Corp was last updated on April 5, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 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.