CMS-1500 Box 24J / 33a • NPI
1629785183
Type 2 Organization (Box 32a/33a)
HIPAA NUCC Taxonomy • CMS Code
207X00000X (CMS 02)
Board-Certified Orthopedic Surgeon (Bone, Joint, Spine & Sports Injury Surgeon)
Box 32 Service Location & ZIP+4
205 BAILEY LN STE F, BENTON, IL, 62812-1921
✓ 9-Digit EDI 837 ZIP+4 (62812-1921)
✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR:
NPI
1629785183 (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 | 1629785183 (NPI-2 Organization / Facility) |
|---|---|
| Provider / Legal Name | DEACONESS ILLINOIS SPECIALTY CLINIC, INC. |
| Plain-English Specialty | Board-Certified Orthopedic Surgeon (Bone, Joint, Spine & Sports Injury Surgeon) NUCC Code: 207X00000X (Orthopaedic Surgery) |
| Certifying / Licensing Body | American Board of Orthopaedic Surgery (ABOS) |
| Practice Location Address | 205 BAILEY LN STE F, BENTON, IL, 62812-1921 |
| Practice Telephone / Fax | Tel: (618) 882-4200 | Fax: (618) 882-4208 |
| 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
🗺️ Open in Google Maps 🏥 More Providers in BENTON
🔒 Are you DEACONESS ILLINOIS SPECIALTY CLINIC, INC.? Get your Verified NPI Clinic Badge or request personal phone/address redaction →
Plain-English Taxonomy & CMS Crosswalk (207X00000X)
What Does Taxonomy Code 207X00000X Mean?
In the HIPAA National Uniform Claim Committee (NUCC) classification, code 207X00000X translates to:
"Board-Certified Orthopedic Surgeon (Bone, Joint, Spine & Sports Injury Surgeon)"
Specialty Clinical Procedures & Therapeutic Classes
Standard Scope of Care (DEACONESS ILLINOIS SPECIALTY CLINIC, INC.)
Typical CPT / Diagnostic Procedures:- Total Knee Arthroplasty (CPT 27447) & Total Hip Arthroplasty (CPT 27130)
- Arthroscopic Rotator Cuff & ACL Ligament Reconstruction
- Intra-Articular Corticosteroid & Hyaluronic Acid Joint Injections (CPT 20610)
- Fracture Reduction, Internal Fixation & Carpal Tunnel Release
- NSAIDs & Selective COX-2 Inhibitors (Meloxicam, Celecoxib, Naproxen)
- Intra-Articular Triamcinolone Acetonide & Methylprednisolone
- Postoperative Venous Thromboembolism (VTE) Prophylaxis (Apixaban, Rivaroxaban)
All Registered NUCC Taxonomies & State Licenses
| Taxonomy Code & Plain-English Description | State License & Primary Status |
|---|---|
207RG0100X — Internal Medicine, GastroenterologyPlain English: Board-Certified Gastroenterologist (Digestive Tract & Liver Specialist) | State: N/A | License: Verified | Primary: Secondary |
208600000X — SurgeryPlain English: Board-Certified Orthopedic Surgeon (Bone, Joint, Spine & Sports Injury Surgeon) | 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 |
207X00000X — Orthopaedic SurgeryPlain English: Board-Certified Orthopedic Surgeon (Bone, Joint, Spine & Sports Injury Surgeon) | State: N/A | License: Verified | Primary: Yes (Primary) |
Medical Billing, RCM & Hospital Credentialing Teams:
Batch-verify up to 25 NPIs free against CMS NPPES + Medicare PECOS + HHS OIG Exclusions with 1-click CSV export.