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ANDERSON MEDICAL GROUP, LLC
NPI 1700807716
General Practice in Maryville, IL

Active since July 22, 2006CLIA 14D2047041 · Waiver
6810 STATE ROUTE 162, SUITE 215, MARYVILLE, IL 62062(618) 288-5711(618) 288-4088 Get Directions Write a Review

NPPES record last updated: August 13, 2025. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Aug 13, 2025, May 19, 2025, Feb 11, 2020 (3 updates tracked since 2020).

About Anderson Medical Group, Llc NPPES

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

ANDERSON MEDICAL GROUP, LLC (NPI 1700807716) is a healthcare organization registered as a general practice in Maryville, Illinois and active in the NPI registry since July 2006. The organization holds a CLIA Waiver certificate valid through September 16, 2028 and lists Michael Marshall, Ceo, as its authorized official.

NPPES Registry Identity

NPI1700807716
Entity TypeOrganization
Primary Taxonomy208D00000X
Legal Business NameANDERSON MEDICAL GROUP, LLC
Location Address6810 STATE ROUTE 162, SUITE 215Maryville, IL 62062-8501
Mailing Address6810 State Route 162, Suite 215Maryville, IL 62062-8501 · (618) 288-5711
Phone(618) 288-5711
Fax(618) 288-4088
Organization SubpartNo
Authorized OfficialMichael MarshallCeo · (618) 391-6402
Enumeration DateJuly 22, 2006
Last NPPES UpdateAugust 13, 20253 updates tracked since enumeration
NPPES CertifiedAugust 13, 2025
✔ NPI 1700807716 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 15

★ Primary SpecialtyGeneral PracticeAllopathic & Osteopathic Physicians
Taxonomy Code208D00000X
Definition
A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee
Also ListedAnesthesiology · Pain MedicineTaxonomy 207LP2900X
Also ListedFamily MedicineTaxonomy 207Q00000X
Also ListedInternal MedicineTaxonomy 207R00000X
Also ListedInternal Medicine · Cardiovascular DiseaseTaxonomy 207RC0000X
Also ListedInternal Medicine · Critical Care MedicineTaxonomy 207RC0200X
Also ListedInternal Medicine · Endocrinology, Diabetes & MetabolismTaxonomy 207RE0101X
Also ListedInternal Medicine · GastroenterologyTaxonomy 207RG0100X
Also ListedInternal Medicine · NephrologyTaxonomy 207RN0300X
Also ListedNeurological SurgeryTaxonomy 207T00000X
Also ListedObstetrics & GynecologyTaxonomy 207V00000X
Also ListedOrthopaedic SurgeryTaxonomy 207X00000X
Also ListedOtolaryngologyTaxonomy 207Y00000X
Also ListedPsychiatry & Neurology · NeurologyTaxonomy 2084N0400X
Also ListedSurgeryTaxonomy 208600000X
6810 STATE ROUTE 162, Maryville, IL 62062
Open in Google Maps ↗

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, Anthem Blue Cross and Blue Shield.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)

Anderson Medical Group, Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

148

Medicare enrollment records show 148 clinicians reassign Medicare billing to Anderson Medical Group, LLC, which bills Medicare for the services they deliver. Of these, 35 practice at this address and 76 within 10 miles. Listed here are the 20 practicing nearest to this location.

Clinicians by Medicare Specialty 21

Nurse Practitioner69
Family Practice15
Diagnostic Radiology8
Cardiovascular Disease (Cardiology)7
Internal Medicine6
Neurosurgery6
Orthopedic Surgery6
General Surgery5
13 other specialties26

Nearest to this location (20)

See all 148
Pei Chung, M.D.
General Surgery
NPI 1669609988
6810 STATE ROUTE 162 STE 100
Maryville, IL 62062
(618) 288-3616
✔ PECOS✔ Accepts MedicareSame address
Sara Grotefendt, NP
Nurse Practitioner
NPI 1255805594
6810 STATE ROUTE 162 STE 105
Maryville, IL 62062
(618) 288-9320
✔ PECOS✔ Accepts MedicareSame address
Thomas Hulsen, M.D.
Obstetrics/Gynecology
NPI 1417060542
6810 STATE ROUTE 162 SUITE 301
Maryville, IL 62062
(618) 288-5699
✔ PECOS✔ Accepts MedicareSame address
Charles Lane, MD
General Surgery
NPI 1164581468
6810 STATE ROUTE 162 STE 100
Maryville, IL 62062
(618) 288-5711
✔ PECOS✔ Accepts MedicareSame address
Kyle Shepperson, MD
Orthopedic Surgery
NPI 1407831704
6810 STATE ROUTE 162 SUITE 10
Maryville, IL 62062
(618) 288-2020
✔ PECOS✔ Accepts MedicareSame address
Patrice Staten, M.D.
Obstetrics/Gynecology
NPI 1154481364
6810 STATE ROUTE 162 SUITE 105
Maryville, IL 62062
(618) 288-9320
✔ PECOS✔ Accepts MedicareSame address
Kelsy Wasmuth, FNP
Nurse Practitioner
NPI 1336659838
6810 STATE ROUTE 162 STE 100
Maryville, IL 62062
(618) 288-3616
✔ PECOS✔ Accepts MedicareSame address
Francisco Tagle, MD
Gastroenterology
NPI 1588323356
6812 STATE ROUTE 162 STE 204
Maryville, IL 62062
(618) 391-5070
✔ PECOS✔ Accepts MedicareSame address
Brenon Abernathie, MD
Plastic and Reconstructive Surgery
NPI 1497916977
6812 STATE ROUTE 162 STE 22
Maryville, IL 62062
(618) 391-5330
✔ PECOS✔ Accepts MedicareSame address
Jason Barnett, MD
Family Practice
NPI 1295728988
6812 STATE ROUTE 162 SUITE 120
Maryville, IL 62062
(618) 288-0044
✔ PECOS✔ Accepts MedicareSame address
Barbara Foner, MD MPH FCCP ABSM
Critical Care (Intensivists)
NPI 1437141090
6812 STATE RTE 162 SUITE 202
Maryville, IL 62062
(618) 288-6844
✔ PECOS✔ Accepts MedicareSame address
Brett Grebing, MD
Orthopedic Surgery
NPI 1447252978
6812 STATE ROUTE 162 SUITE 123
Maryville, IL 62062
(618) 288-9460
✔ PECOS✔ Accepts MedicareSame address
Rafe Heng, D.O., FACC
Cardiovascular Disease (Cardiology)
NPI 1477560126
6812 STATE RTE 162 SUITE 202
Maryville, IL 62062
(618) 288-1748
✔ PECOS✔ Accepts MedicareSame address
Sriraj Kanungo, M.D.
Nephrology
NPI 1548355621
6812 STATE ROUTE 162 STE 121
Maryville, IL 62062
(618) 391-5690
✔ PECOS✔ Accepts MedicareSame address
Tibor Kopjas, M.D.
Internal Medicine
NPI 1952332918
6812 STATE ROUTE 162 STE 209
Maryville, IL 62062
(618) 391-5061
✔ PECOS✔ Accepts MedicareSame address
Eddie Paulk, D.O.
Internal Medicine
NPI 1003813601
6812 STATE ROUTE 162 STE 21
Maryville, IL 62062
(618) 288-5566
✔ PECOS✔ Accepts MedicareSame address
Henry Purcell, M.D.
Nephrology
NPI 1467530410
6812 STATE ROUTE 162 STE 121
Maryville, IL 62062
(618) 391-6910
✔ PECOS✔ Accepts MedicareSame address
Edmundo Rodriguez-Frias, MD
Gastroenterology
NPI 1912117912
6812 STATE ROUTE 162 SUITE 204
Maryville, IL 62062
(618) 391-5070
✔ PECOS✔ Accepts MedicareSame address
Terry Burk, MD
Diagnostic Radiology
NPI 1124062757
6800 STATE ROUTE 162 ANDERSON HOSPITAL DEPT OF RADIOLOGY
Maryville, IL 62062
(618) 288-5711
✔ PECOS✔ Accepts MedicareSame address
Riaz Naseer, M.D.
Neurology
NPI 1245345537
6828 STATE ROUTE 162
Maryville, IL 62062
(618) 288-5906
✔ PECOS✔ Accepts MedicareSame address
See all 148 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 14D2047041

Anderson Medical Group · Maryville, IL
Active · expires Sep 16, 2028
CLIA Number14D2047041
Laboratory TypePhysician Office
Certificate Effective DateSeptember 17, 2026
Certificate Expiration DateSeptember 16, 2028
Laboratory DirectorBarbara Foner M D
Laboratory Phone(618) 288-6844
Laboratory LocationAnderson Medical Group6812 State Route 162 - Ste 202, Maryville, IL 62062
CLIA data matches this NPI record on: Name
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 Anderson Medical Group, LLC's NPI number?

The NPI number for Anderson Medical Group, LLC is 1700807716. It was assigned to this organization in the NPPES registry on July 22, 2006.

Where is Anderson Medical Group, LLC located?

Anderson Medical Group, LLC is located at 6810 State Route 162 Suite 215, Maryville, IL 62062. The listed phone number is (618) 288-5711.

What is Anderson Medical Group, LLC's specialty?

The primary specialty registered for this NPI is General Practice with taxonomy code 208D00000X.

Is Anderson Medical Group, LLC enrolled in Medicare?

Yes. Anderson Medical Group, LLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Anderson Medical Group, LLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 148 clinicians in 21 Medicare specialties reassign their Medicare billing to Anderson Medical Group, LLC. 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 (69), Family Practice (15) and Diagnostic Radiology (8). Of these, 35 practice at this address and 76 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Anderson Medical Group, LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 14D2047041) is associated with this NPI, valid through September 16, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Anderson Medical Group, LLC accept?

Health plans from Ambetter Health, Ambetter Health of Delaware and Anthem Blue Cross and Blue Shield list Anderson Medical Group, LLC 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 Anderson Medical Group, LLC was last updated on August 13, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 months 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.