CMS-1500 Box 24J / 33a • NPI
1619684172
Type 2 Organization (Box 32a/33a)
HIPAA NUCC Taxonomy • CMS Code
207RI0011X (CMS C3)
Board-Certified Internist (Adult Diagnostic & Chronic Disease Physician)
Box 32 Service Location & ZIP+4
205 S BURNS AVE, SPARTA, IL, 62286-1867
✓ 9-Digit EDI 837 ZIP+4 (62286-1867)
✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR:
NPI
1619684172 (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
Official CMS NPPES Credential & Practice Profile
| 10-Digit NPI Number | 1619684172 (NPI-2 Organization / Facility) |
|---|---|
| Provider / Legal Name | DEACONESS ILLINOIS SPECIALTY CLINIC, INC. |
| Plain-English Specialty | Board-Certified Internist (Adult Diagnostic & Chronic Disease Physician) NUCC Code: 207RI0011X (Internal Medicine, Interventional Cardiology) |
| Certifying / Licensing Body | American Board of Internal Medicine (ABIM) |
| Practice Location Address | 205 S BURNS AVE, SPARTA, IL, 62286-1867 |
| Practice Telephone / Fax | Tel: (618) 443-2858 | Fax: (618) 939-4256 |
| Administrative Mailing Address | PO BOX 34266, BELFAST, ME, 04915-0620 |
| Enumeration & Last Sync | Enumerated: 2022-11-03 | CMS Record Updated: 2023-01-26 |
| Authorized Official | KYLE DILLMAN (Secretary Treasurer) |
Clinic Location, Accessibility & Directions
📍 Practice Location & Patient Access
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Plain-English Taxonomy & CMS Crosswalk (207RI0011X)
What Does Taxonomy Code 207RI0011X Mean?
In the HIPAA National Uniform Claim Committee (NUCC) classification, code 207RI0011X translates to:
"Board-Certified Internist (Adult Diagnostic & Chronic Disease Physician)"
Specialty Clinical Procedures & Therapeutic Classes
Standard Scope of Care (DEACONESS ILLINOIS SPECIALTY CLINIC, INC.)
Typical CPT / Diagnostic Procedures:- Complex Multi-System Adult Diagnostic Workup (CPT 99204–99215)
- Preoperative Medical Risk Assessment & Cardiac Clearance
- Chronic Kidney, Hepatic & Metabolic Panel Interpretation
- Adult Inpatient Hospitalist Management & Discharge Coordination
- Antihypertensives (ACE Inhibitors, ARBs, Calcium Channel Blockers, Thiazides)
- Oral Antidiabetic Agents, Basal/Bolus Insulins & Lipid-Lowering Statins
- Direct Oral Anticoagulants (Apixaban, Rivaroxaban) & Antiplatelets
- Levothyroxine (Hypothyroidism) & Proton Pump Inhibitors (Pantoprazole)
All Registered NUCC Taxonomies & State Licenses
| Taxonomy Code & Plain-English Description | State License & Primary Status |
|---|---|
363A00000X — Physician AssistantPlain English: Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Physician Assistant | State: N/A | License: Verified | Primary: Secondary |
363AM0700X — Physician Assistant, MedicalPlain English: Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Physician Assistant, Medical | State: N/A | License: Verified | Primary: Secondary |
363L00000X — Nurse PractitionerPlain English: Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner | State: N/A | License: Verified | Primary: Secondary |
207RI0011X — Internal Medicine, Interventional CardiologyPlain English: Board-Certified Internist (Adult Diagnostic & Chronic Disease Physician) | State: N/A | License: Verified | Primary: Yes (Primary) |
Medical Billing, RCM & Hospital Credentialing Teams:
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