DEACONESS ILLINOIS SPECIALTY CLINIC, INC. — NPI 1578417705 (Licensed Outpatient Medical Clinic / Urgent Care & Ambulatory Center in BENTON, IL)

CMS-1500 Box 24J / 33a • NPI

1578417705

Type 2 Organization (Box 32a/33a)

HIPAA NUCC Taxonomy • CMS Code

261QR1300X (CMS B4[14])

Licensed Outpatient Medical Clinic / Urgent Care & Ambulatory Center

Box 32 Service Location & ZIP+4

205 BAILEY LN STE F, BENTON, IL, 62812-1921

✓ 9-Digit EDI 837 ZIP+4 (62812-1921)

Practice Phone & Referral Fax

(618) 918-0645

Fax: (618) 918-6046

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1578417705 (DEACONESS ILLINOIS SPECIALTY CLINIC, INC.) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

Institutional Type-2 NPI facilities enroll via CMS-855A institutional provider agreements rather than individual Order & Referring PECOS.

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1578417705` (NPI-2 Organization / Facility)
Provider / Legal Name	DEACONESS ILLINOIS SPECIALTY CLINIC, INC.
Plain-English Specialty	Licensed Outpatient Medical Clinic / Urgent Care & Ambulatory Center NUCC Code: `261QR1300X` (Clinic/Center, Rural Health)
Certifying / Licensing Body	Accreditation Association for Ambulatory Health Care (AAAHC) / CMS
Practice Location Address	205 BAILEY LN STE F, BENTON, IL, 62812-1921
Practice Telephone / Fax	Tel: (618) 918-0645 \| Fax: (618) 918-6046
Administrative Mailing Address	205 BAILEY LN STE F, BENTON, IL, 62812-1921
Enumeration & Last Sync	Enumerated: 2026-02-24 \| CMS Record Updated: 2026-03-12
Authorized Official	KYLE DILLMAN (Secretary)

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

205 BAILEY LN STE F, BENTON, IL, 62812-1921

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Plain-English Taxonomy & CMS Crosswalk (261QR1300X)

What Does Taxonomy Code 261QR1300X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 261QR1300X translates to:
"Licensed Outpatient Medical Clinic / Urgent Care & Ambulatory Center"

CMS-1500 Medicare Specialty Crosswalk: CMS Code B4[14] (Rural Health Clinic)
Certifying / Accrediting Authority: Accreditation Association for Ambulatory Health Care (AAAHC) / CMS
Clinical Scope: Same-day outpatient consultations, urgent walk-in medical care, vaccinations, and day-case diagnostic procedures.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (DEACONESS ILLINOIS SPECIALTY CLINIC, INC.)

Typical CPT / Diagnostic Procedures:

Walk-In Urgent Care Evaluation, Point-of-Care Testing & X-Ray
Same-Day Ambulatory Endoscopy, Cataract & Minor Surgical Procedures

Common Therapeutic Classes:

Outpatient Oral Antimicrobials, Analgesics, Nebulizers & Vaccines

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`261QR1300X` — Clinic/Center, Rural Health Plain English: Licensed Outpatient Medical Clinic / Urgent Care & Ambulatory Center	State: N/A \| License: `Verified` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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DEACONESS ILLINOIS SPECIALTY CLINIC, INC. (NPI #1578417705)