SUPPORTIVE CARE OF ILLINOIS PC
NPI 1861199911
Psychologist - Clinical in Marshall, IL

Q: What is Supportive Care Of Illinois PC's NPI number?

The NPI number for Supportive Care Of Illinois PC is 1861199911. It was assigned to this organization in the NPPES registry on February 9, 2023.

Q: What is Supportive Care Of Illinois PC's specialty?

The primary specialty registered for this NPI is Psychologist, specializing in Clinical, with taxonomy code 103TC0700X.

Active since February 09, 2023

410 N 2ND ST, MARSHALL, IL 62441(866) 708-1240 Get Directions Write a Review

NPPES record last updated: February 9, 2023. Verified against the NPPES registry weekly; last sync: October 25, 2026.

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About Supportive Care Of Illinois Pc NPPES

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

SUPPORTIVE CARE OF ILLINOIS PC (NPI 1861199911) is a healthcare organization registered as a clinical in Marshall, Illinois and active in the NPI registry since February 2023. The organization lists Dov Newmark, Ceo, as its authorized official.

NPPES Registry Identity

NPI1861199911

Entity TypeOrganization

Primary Taxonomy103TC0700X

Legal Business NameSUPPORTIVE CARE OF ILLINOIS PC

Location Address410 N 2ND STMarshall, IL 62441-1010

Mailing Address27 Randolph RdHowell, NJ 07731-8611

Phone(866) 708-1240

Organization SubpartNo

Authorized OfficialDov NewmarkCeo · (718) 298-2753

Enumeration DateFebruary 9, 2023

NPPES CertifiedFebruary 8, 2023

✔ NPI 1861199911 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyPsychologist · ClinicalBehavioral Health & Social Service Providers

Taxonomy Code103TC0700X

Definition

A psychologist who provides continuing and comprehensive mental and behavioral health care for individuals and families; consultation to agencies and communities; training, education and supervision; and research-based practice. It is a specialty in breadth -- one that is broadly inclusive of severe psychopathology -- and marked by comprehensiveness and integration of knowledge and skill from a broad array of disciplines within and outside of psychology proper. The scope of clinical psychology encompasses all ages, multiple diversities and varied systems.

Also ListedSocial Worker · ClinicalTaxonomy 1041C0700X

Also ListedNurse PractitionerTaxonomy 363L00000X

410 N 2ND ST, Marshall, IL 62441

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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

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Supportive Care Of Illinois Pc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 5 clinicians reassign Medicare billing to Supportive Care Of Illinois PC, which bills Medicare for the services they deliver. Of these, 1 practice at this address. They are listed nearest first.

Clinicians, nearest first (5)

Abidemi Balogun, PMHNP

Nurse Practitioner

NPI 1205605235

410 N 2ND ST
Marshall, IL 62441

(718) 506-1115

✔ PECOS✔ Accepts MedicareSame address

Cawonda Wilson, PMHNP-BC

Nurse Practitioner

NPI 1417648148

2501 CHATHAM RD
Springfield, IL 62704

(253) 922-4027

✔ PECOS109 mi

Shola Owoyemi

Nurse Practitioner

NPI 1699460121

5875 N LINCOLN AVE STE 102-3
Chicago, IL 60659

(773) 552-5861

✔ PECOS180 mi

Comfort Lacy, NP

Nurse Practitioner

NPI 1497221162

2222 E STATE ST STE 209
Rockford, IL 61104

(815) 988-8500

✔ PECOS✔ Accepts Medicare211 mi

Robert Glenn, MD

Psychiatry

NPI 1902033210

501 W REDLANDS BLVD STE B
Redlands, CA 92373

(909) 686-6233

✔ PECOS✔ Accepts Medicare1,669 mi

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 Supportive Care Of Illinois PC's NPI number?

The NPI number for Supportive Care Of Illinois PC is 1861199911. It was assigned to this organization in the NPPES registry on February 9, 2023.

Where is Supportive Care Of Illinois PC located?

Supportive Care Of Illinois PC is located at 410 N 2nd St, Marshall, IL 62441. The listed phone number is (866) 708-1240.

What is Supportive Care Of Illinois PC's specialty?

The primary specialty registered for this NPI is Psychologist, specializing in Clinical, with taxonomy code 103TC0700X.

Is Supportive Care Of Illinois PC enrolled in Medicare?

Yes. Supportive Care Of Illinois PC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Supportive Care Of Illinois PC?

According to the CMS Revalidation Reassignment List (October 2026 release), 5 clinicians in 2 Medicare specialties reassign their Medicare billing to Supportive Care Of Illinois PC. 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 (4) and Psychiatry (1). Of these, 1 practice at this address. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

When was this NPI record last updated?

The NPPES record for Supportive Care Of Illinois PC was last updated on February 9, 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.