DEACONESS IL CLINIC BAILEY LN
NPI 1790401081
Family Medicine in Benton, IL
About Deaconess Il Clinic Bailey Ln NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
DEACONESS IL CLINIC BAILEY LN (NPI 1790401081) is a healthcare organization registered as a family medicine in Benton, Illinois and active in the NPI registry since October 2022. The organization holds a CLIA Waiver certificate valid through December 18, 2027 and lists Kyle Dillman, Secretary, as its authorized official.
NPPES Registry Identity
Specialties & Licenses 2
Other Names 1
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 Clinic Bailey Ln is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
29Medicare enrollment records show 29 clinicians reassign Medicare billing to Deaconess Il Clinic Bailey Ln, which bills Medicare for the services they deliver. Of these, 1 practice within 10 miles. Listed here are the 20 practicing nearest to this location.
Clinicians by Medicare Specialty 5
Nearest to this location (20)
See all 29Source: 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 14D2335935
Deaconess Illinois Clinic Gi & Family Medicine · Benton, 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 Clinic, Inc's NPI number?
The NPI number for Deaconess Illinois Clinic, Inc is 1790401081. It was assigned to this organization in the NPPES registry on October 18, 2022. The provider is doing business as Deaconess Il Clinic Bailey Ln.
Where is Deaconess Illinois Clinic, Inc located?
Deaconess Illinois 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 Clinic, Inc's specialty?
The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.
Is Deaconess Illinois Clinic, Inc enrolled in Medicare?
Yes. Deaconess Illinois Clinic, Inc is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Deaconess Illinois Clinic, Inc?
According to the CMS Revalidation Reassignment List (October 2026 release), 29 clinicians in 5 Medicare specialties reassign their Medicare billing to Deaconess Illinois 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 (18), Family Practice (8) and Emergency Medicine (1). Of these, 1 practice within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Does Deaconess Illinois Clinic, Inc hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 14D2335935) is associated with this NPI, valid through December 18, 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 January 26, 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 Clinic Bailey Ln · NPI 1790401081
Family Medicine organization in Benton, Illinois. Organization record, active in the CMS NPPES registry since October 18, 2022.
## Identity
- **NPI:** 1790401081 (Entity type: Organization)
- **Enumerated:** October 18, 2022
- **Primary specialty:** Family Medicine · taxonomy 207Q00000X
- **Legal business name:** Deaconess Illinois Clinic, Inc
- **Organization subpart:** No
- **Authorized official:** Kyle Dillman, SECRETARY
## Practice location
- **Address:** 205 BAILEY LN STE F, Benton, IL 62812-1921
- **Phone:** (618) 882-4200 · **Fax:** (618) 882-4208
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 29 clinicians in 5 Medicare specialties reassign Medicare billing to this organization (form CMS-855R); largest: Nurse Practitioner (18), Family Practice (8), Emergency Medicine (1); 1 practice within 10 miles; [full list](https://npiprofile.com/npi/1790401081/clinicians) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** January 26, 2023
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1790401081) · Data from the CMS NPPES public registry.