Active NPI 1952309981 Individual Practitioner Female Practitioner

Stacy L Purcell , PA

Physician Assistant • Ottawa, IL

✓ Accepts Medicare Assignment

Professional Overview & Biography Verified Profile Summary

Stacy Purcell, PA is a certified Physician Assistant practicing in Ottawa, IL. With approximately 22 years of clinical experience since completing medical education in 2004, Stacy Purcell delivers high-quality medical care to the local community at 123 W MICHIGAN ST.

Stacy Purcell is affiliated with Pinnacle Dermatology Sc and accepts Medicare assignment.

Frequently performed procedures and clinical services include destruction of precancer skin growth, 2-14 growths, established patient outpatient office visit, destruction of skin growth. Full Medicare procedure pricing transparency rates and service volume details are listed on this profile.

Practice Location & Contact Primary Location

Practice Address

123 W Michigan St

Ottawa, IL 613502028

Telephone 8158600757

Fax 7089232529

Medicare Profile & Education

Medical School

Other

Graduation Year

2004

Medicare Assignment

✓ Accepts Assignment

Telehealth Flag

In-Person Only

Specialty Benchmarks & Practice Insights

Comparative analytics for Physician Assistant in Ottawa, IL

Senior Veteran Specialist (>20 Yrs)

Practitioner Clinical Experience

22 Yrs +4.0 yrs vs City Avg

City Avg: 18.0 Yrs

State Avg: 11.7 Yrs

Regional Practice Density

4 Specialists

Practicing in Ottawa, IL (4958 Statewide)

Telehealth Adoption Rate

0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount

77.1% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Clinical Seniority & Experience Comparison

Dr. Purcell (22 Years) 22 Yrs

Ottawa Specialty Average (18.0 Years) 18.0 Yrs

Performed Procedures & Service Volume

Top Medicare Part B procedures performed by this practitioner

CMS Official Data (2024)

Reporting Year:

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	1,856	329	$18.50	$5.16
99213 Established patient office or other outpatient visit, typically 15 minutes	1,000	750	$263.76	$73.71
17000 Destruction of skin growth	615	458	$193.23	$41.25
17110 Destruction of up to 14 skin growths	422	348	$320.52	$84.03
11102 Tangential biopsy of single skin lesion	288	247	$283.15	$65.79
11103 Biopsy of related skin growth, each additional growth	126	75	$142.39	$39.75
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	125	125	$324.81	$89.79
11300 Shaving of 0.5 centimeters or less skin growth of the trunk, arms, or legs	98	75	$282.60	$56.26
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	85	77	$162.95	$44.83
12032 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.6-7.5 cm	83	72	$866.09	$235.95
11301 Shaving of skin growth of body, arms, or legs, 0.6-1.0 cm	75	64	$343.65	$85.31
17004 Destruction of precancer skin growth, 15 or more growths	70	51	$475.85	$131.20
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	37	32	$372.42	$104.06
11602 Removal of cancer skin growth of body, arms, or legs, 1.1-2.0 cm	33	30	$701.13	$94.83
11402 Removal of noncancer skin growth of body, arms, or legs, 1.1-2.0 cm	30	27	$493.77	$68.84
69100 Biopsy of ear	26	24	$272.39	$57.05
11310 Shaving of 0.5 centimeters or less skin growth of face, ears, eyelids, nose, lips, or mouth	24	23	$325.74	$77.88
11306 Shaving of skin growth of scalp, neck, hands, feet, or genitals, 0.6-1.0 cm	18	17	$345.60	$88.69
11603 Removal of cancer skin growth of body, arms, or legs, 2.1-3.0 cm	17	16	$802.50	$111.98
12031 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.5 cm or less	16	15	$748.91	$209.01
11305 Shaving of skin growth of scalp, neck, hands, feet, or genitals, 0.5 cm or less	16	16	$296.59	$70.08
11302 Shaving of skin growth of body, arms, or legs, 1.1-2.0 cm	15	13	$388.34	$94.06
11401 Removal of noncancer skin growth of body, arms, or legs, 0.6-1.0 cm	14	12	$447.17	$84.63
99202 New patient office or other outpatient visit, typically 20 minutes	14	14	$207.35	$58.23
11311 Shaving of skin growth of face, ears, eyelids, nose, lips, or mouth, 0.6-1.0 cm	13	11	$388.63	$100.26

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	1,652	283	$20.51	$5.26
99213 Established patient office or other outpatient visit, typically 15 minutes	814	652	$271.06	$73.50
17000 Destruction of skin growth	482	380	$203.01	$42.05
17110 Destruction of up to 14 skin growths	392	331	$344.52	$84.78
11102 Tangential biopsy of single skin lesion	213	192	$310.34	$69.03
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	147	147	$338.33	$91.64
11103 Biopsy of related skin growth, each additional growth	106	63	$162.90	$40.42
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	104	90	$167.96	$45.88
11300 Shaving of 0.5 centimeters or less skin growth of the trunk, arms, or legs	100	75	$307.86	$55.19
17004 Destruction of precancer skin growth, 15 or more growths	96	74	$500.89	$136.55
11301 Shaving of skin growth of body, arms, or legs, 0.6-1.0 cm	71	61	$371.89	$90.04
12032 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.6-7.5 cm	68	59	$922.63	$238.25
J3301 Injection, triamcinolone acetonide, not otherwise specified, 10 mg	47	13	$5.22	$1.08
99202 New patient office or other outpatient visit, typically 20 minutes	37	37	$227.18	$56.79
11310 Shaving of 0.5 centimeters or less skin growth of face, ears, eyelids, nose, lips, or mouth	36	34	$354.39	$84.73
11602 Removal of cancer skin growth of body, arms, or legs, 1.1-2.0 cm	31	29	$752.71	$99.01
69100 Biopsy of ear	30	30	$301.09	$57.51
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	30	25	$383.24	$104.57
11305 Shaving of skin growth of scalp, neck, hands, feet, or genitals, 0.5 cm or less	24	24	$320.22	$61.98
11900 Injection into skin growth, 1-7 growths	24	13	$170.82	$37.53
11402 Removal of noncancer skin growth of body, arms, or legs, 1.1-2.0 cm	23	22	$523.04	$69.50
11311 Shaving of skin growth of face, ears, eyelids, nose, lips, or mouth, 0.6-1.0 cm	20	18	$421.25	$102.37
11302 Shaving of skin growth of body, arms, or legs, 1.1-2.0 cm	20	17	$423.58	$102.42
11306 Shaving of skin growth of scalp, neck, hands, feet, or genitals, 0.6-1.0 cm	16	16	$377.76	$93.00
17262 Destruction of cancer skin growth of trunk, arms, or legs, 1.1-2.0 cm	15	14	$532.75	$139.68
11104 Punch biopsy, first skin growth	15	15	$389.95	$101.05
11603 Removal of cancer skin growth of body, arms, or legs, 2.1-3.0 cm	14	14	$851.10	$121.64

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	1,691	287	$21.99	$5.38
99213 Established patient office or other outpatient visit, typically 15 minutes	811	617	$278.00	$74.59
17000 Destruction of skin growth	504	385	$211.59	$41.70
17110 Destruction of up to 14 skin growths	417	332	$362.77	$87.41
11102 Tangential biopsy of single skin lesion	265	232	$325.65	$70.59
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	180	180	$345.96	$92.41
11103 Biopsy of related skin growth, each additional growth	100	64	$173.37	$40.93
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	93	86	$171.00	$46.35
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	91	84	$394.00	$105.13
17004 Destruction of precancer skin growth, 15 or more growths	73	58	$511.62	$137.08
12032 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.6-7.5 cm	53	50	$983.64	$241.54
11301 Shaving of skin growth of body, arms, or legs, 0.6-1.0 cm	52	46	$394.71	$90.50
11300 Shaving of 0.5 centimeters or less skin growth of the trunk, arms, or legs	52	45	$324.93	$60.00
99202 New patient office or other outpatient visit, typically 20 minutes	41	41	$244.62	$60.07
11310 Shaving of 0.5 centimeters or less skin growth of face, ears, eyelids, nose, lips, or mouth	32	30	$376.92	$89.64
11602 Removal of cancer skin growth of body, arms, or legs, 1.1-2.0 cm	27	26	$804.27	$97.37
11302 Shaving of skin growth of body, arms, or legs, 1.1-2.0 cm	16	15	$456.75	$109.86
11305 Shaving of skin growth of scalp, neck, hands, feet, or genitals, 0.5 cm or less	15	15	$342.06	$64.61
17262 Destruction of cancer skin growth of trunk, arms, or legs, 1.1-2.0 cm	15	14	$572.46	$131.32
11311 Shaving of skin growth of face, ears, eyelids, nose, lips, or mouth, 0.6-1.0 cm	14	14	$457.59	$109.15
11306 Shaving of skin growth of scalp, neck, hands, feet, or genitals, 0.6-1.0 cm	13	13	$400.11	$101.18
69100 Biopsy of ear	11	11	$319.65	$61.18

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	1,646	277	$21.99	$5.27
99213 Established patient office or other outpatient visit, typically 15 minutes	742	558	$265.50	$76.42
17000 Destruction of skin growth	530	377	$211.59	$43.02
17110 Destruction of up to 14 skin growths	354	304	$363.21	$88.64
11102 Tangential biopsy of single skin lesion	266	243	$325.65	$73.95
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	173	173	$345.96	$93.92
11103 Biopsy of related skin growth, each additional growth	137	77	$173.37	$42.66
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	130	102	$378.75	$108.77
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	112	101	$157.45	$46.69
17004 Destruction of precancer skin growth, 15 or more growths	65	45	$511.62	$136.28
11301 Shaving of skin growth of body, arms, or legs, 0.6-1.0 cm	48	43	$394.71	$92.81
11300 Shaving of 0.5 centimeters or less skin growth of the trunk, arms, or legs	47	41	$324.93	$54.97
99202 New patient office or other outpatient visit, typically 20 minutes	42	42	$244.62	$60.94
J3301 Injection, triamcinolone acetonide, not otherwise specified, 10 mg	35	15	$8.00	$1.28
12032 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.6-7.5 cm	32	31	$983.64	$254.67
11602 Removal of cancer skin growth of body, arms, or legs, 1.1-2.0 cm	24	24	$804.27	$103.24
11900 Injection into skin growth, 1-7 growths	23	14	$178.35	$37.63
11311 Shaving of skin growth of face, ears, eyelids, nose, lips, or mouth, 0.6-1.0 cm	22	21	$446.16	$105.84
11310 Shaving of 0.5 centimeters or less skin growth of face, ears, eyelids, nose, lips, or mouth	22	21	$376.92	$84.71
11305 Shaving of skin growth of scalp, neck, hands, feet, or genitals, 0.5 cm or less	19	17	$342.06	$61.16
11306 Shaving of skin growth of scalp, neck, hands, feet, or genitals, 0.6-1.0 cm	19	19	$400.11	$96.12
69100 Biopsy of ear	15	14	$319.65	$63.04
11302 Shaving of skin growth of body, arms, or legs, 1.1-2.0 cm	11	11	$456.75	$112.36

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	1,205	229	$20.64	$4.91
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	450	338	$146.08	$37.90
17000 Destruction of skin growth	436	318	$210.57	$41.70
99213 Established patient office or other outpatient visit, typically 15 minutes	431	356	$240.20	$62.63
17110 Destruction of up to 14 skin growths	300	238	$362.16	$85.95
11102 Tangential biopsy of single skin lesion	253	218	$325.65	$71.55
11103 Biopsy of related skin growth, each additional growth	137	81	$173.37	$44.08
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	127	127	$345.96	$90.29
11300 Shaving of 0.5 centimeters or less skin growth of the trunk, arms, or legs	70	58	$324.93	$53.52
99202 New patient office or other outpatient visit, typically 20 minutes	64	64	$244.62	$62.89
17004 Destruction of precancer skin growth, 15 or more growths	52	36	$511.62	$131.51
12032 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.6-7.5 cm	42	34	$983.64	$247.51
11310 Shaving of 0.5 centimeters or less skin growth of face, ears, eyelids, nose, lips, or mouth	40	38	$376.92	$83.88
11301 Shaving of skin growth of body, arms, or legs, 0.6-1.0 cm	40	34	$394.71	$90.35
11602 Removal of cancer skin growth of body, arms, or legs, 1.1-2.0 cm	33	28	$804.27	$102.05
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	24	23	$347.91	$91.58
J3301 Injection, triamcinolone acetonide, not otherwise specified, 10 mg	22	12	$8.00	$1.48
11305 Shaving of skin growth of scalp, neck, hands, feet, or genitals, 0.5 cm or less	18	16	$342.06	$65.46
11900 Injection into skin growth, 1-7 growths	14	11	$178.35	$42.51
11311 Shaving of skin growth of face, ears, eyelids, nose, lips, or mouth, 0.6-1.0 cm	13	12	$446.16	$109.56
12031 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.5 cm or less	11	11	$823.38	$209.93

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	1,347	227	$10.00	$4.65
99213 Established patient office or other outpatient visit, typically 15 minutes	492	368	$133.00	$61.27
17000 Destruction of skin growth	476	323	$123.00	$39.76
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	378	252	$80.00	$36.89
17110 Destruction of up to 14 skin growths	302	233	$206.00	$83.60
11102 Tangential biopsy of single skin lesion	280	257	$182.00	$69.94
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	200	200	$198.00	$89.66
11103 Biopsy of related skin growth, each additional growth	140	80	$98.00	$43.51
99202 New patient office or other outpatient visit, typically 20 minutes	82	82	$137.00	$63.10
11300 Shaving of 0.5 centimeters or less skin growth of the trunk, arms, or legs	71	57	$181.00	$49.80
12032 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.6-7.5 cm	68	55	$560.00	$250.91
11301 Shaving of skin growth of body, arms, or legs, 0.6-1.0 cm	61	52	$222.00	$88.55
17004 Destruction of precancer skin growth, 15 or more growths	46	31	$268.00	$125.39
J3301 Injection, triamcinolone acetonide, not otherwise specified, 10 mg	35	14	$8.00	$1.59
11602 Removal of cancer skin growth of body, arms, or legs, 1.1-2.0 cm	31	23	$461.00	$102.78
11310 Shaving of 0.5 centimeters or less skin growth of face, ears, eyelids, nose, lips, or mouth	29	27	$211.00	$81.87
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	25	17	$196.00	$90.04
11302 Shaving of skin growth of body, arms, or legs, 1.1-2.0 cm	20	19	$262.00	$109.24
11402 Removal of noncancer skin growth of body, arms, or legs, 1.1-2.0 cm	19	19	$311.00	$69.55
11900 Injection into skin growth, 1-7 growths	19	13	$104.00	$36.66
11603 Removal of cancer skin growth of body, arms, or legs, 2.1-3.0 cm	17	15	$529.00	$118.05
11305 Shaving of skin growth of scalp, neck, hands, feet, or genitals, 0.5 cm or less	17	14	$182.00	$58.94
11311 Shaving of skin growth of face, ears, eyelids, nose, lips, or mouth, 0.6-1.0 cm	16	16	$207.00	$111.73
11306 Shaving of skin growth of scalp, neck, hands, feet, or genitals, 0.6-1.0 cm	12	12	$226.00	$87.20
11104 Punch biopsy, first skin growth	12	11	$229.00	$101.30
12031 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.5 cm or less	12	12	$441.00	$202.39

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	843	152	$9.77	$4.33
17000 Destruction of skin growth	308	231	$121.60	$40.56
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	298	233	$79.30	$35.87
11100 Biopsy of single growth of skin and/or tissue	248	218	$193.19	$74.13
99213 Established patient office or other outpatient visit, typically 15 minutes	230	188	$130.87	$59.65
17110 Destruction of up to 14 skin growths	190	152	$205.08	$86.73
11101 Biopsy of each additional growth of skin and/or tissue	162	96	$60.80	$27.03
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	139	139	$195.13	$89.19
99202 New patient office or other outpatient visit, typically 20 minutes	103	103	$136.45	$61.84
12032 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.6-7.5 cm	46	36	$560.00	$247.67
11300 Shaving of 0.5 centimeters or less skin growth of the trunk, arms, or legs	42	34	$181.00	$53.02
J3301 Injection, triamcinolone acetonide, not otherwise specified, 10 mg	35	15	$8.00	$1.77
17004 Destruction of precancer skin growth, 15 or more growths	30	27	$268.00	$118.73
11301 Shaving of skin growth of body, arms, or legs, 0.6-1.0 cm	26	24	$222.00	$92.23
11602 Removal of cancer skin growth of body, arms, or legs, 1.1-2.0 cm	25	21	$461.00	$100.31
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	17	13	$191.27	$85.12
11603 Removal of cancer skin growth of body, arms, or legs, 2.1-3.0 cm	16	16	$529.00	$117.56

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	286	71	$12.01	$4.76
11101 Biopsy of each additional growth of skin and/or tissue	121	64	$58.50	$28.35
11100 Biopsy of single growth of skin and/or tissue	111	106	$140.87	$82.34
17000 Destruction of skin growth	108	96	$102.23	$41.56
99213 Established patient office or other outpatient visit, typically 15 minutes	102	94	$105.73	$63.30
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	74	53	$70.64	$37.06
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	72	72	$133.37	$89.31
17110 Destruction of up to 14 skin growths	62	44	$152.67	$93.08
99202 New patient office or other outpatient visit, typically 20 minutes	29	29	$106.04	$62.07
17004 Destruction of precancer skin growth, 15 or more growths	16	12	$221.98	$125.87
12032 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.6-7.5 cm	14	14	$414.88	$252.72

Medical Specialties & State Licenses

Physician Assistant Primary Specialty

NUCC Taxonomy Code: 363A00000X

State License IL 85002282

A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.

Hospital & Practice Group Affiliations

Pinnacle Dermatology Sc

1124 Essington Rd, Joliet, IL 604358442

Phone: 8157448554

Pinnacle Dermatology Sc

123 W Michigan St, Ottawa, IL 613502028

Phone: 8157448554

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

13 Associated Practitioners

Dr. Henry Fuentes , MD

Orthopaedic Surgery - Sports Medicine

NPI 1043218050

Doctor of Medicine (M.D.)

Susan Ruda , RN, MS, APN, ONC

Clinical Nurse Specialist

NPI 1104824135

Registered Nurse, Master of Science, Advanced Practice Nurse, ONC

Dr. Russell Glantz , MD

Psychiatry & Neurology - Neurology

NPI 1235137233

Doctor of Medicine (M.D.)

Dr. Scott Price , MD

Orthopaedic Surgery

NPI 1285632232

Doctor of Medicine (M.D.)

Dr. Kevin Luke , MD

Orthopaedic Surgery

NPI 1437157443

Doctor of Medicine (M.D.)

Dr. Robert Semba , MD

Orthopaedic Surgery

NPI 1487652400

Doctor of Medicine (M.D.)

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

9 Historical Events

📍

Updated Practice Location June 26, 2019

Registered at 123 W MICHIGAN ST, OTTAWA, IL 613502028 (Tel: 8158600757)

📍

Updated Business Mailing Address June 26, 2019

Registered at 123 W MICHIGAN ST, OTTAWA, IL 613502028 (Tel: 8157919553)

👤

Provider Name / Credentials Updated June 26, 2019

Recorded as STACY PURCELL, P.A.

✅

NPI Profile Active November 07, 2007

NPI status registered as active in NPPES database

📍

Updated Practice Location November 07, 2007

Registered at 7600 W COLLEGE DR, PALOS HEIGHTS, IL 604631001 (Tel: 7083610600)

📍

Updated Business Mailing Address November 07, 2007

Registered at 7600 W COLLEGE DR, PALOS HEIGHTS, IL 604631001 (Tel: 7083610600)

👤

Provider Name / Credentials Updated November 07, 2007

Recorded as STACEY PURCELL, P.A.

🎓

Medical Taxonomy / Specialty Registered (Primary Specialty) November 07, 2007

Physician Assistant (License #85002282 in IL)

🟢

Initial NPI Registration & Enumeration July 13, 2005

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1952309981

Entity Type:

Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)

Enumeration Date: July 13, 2005

Last Update: June 26, 2019

Sole Proprietor: No

Update or Correct Profile

Mailing Address

123 W Michigan St

Ottawa, IL 613502028

Phone: 8157919553

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).

⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.