Illini Family Medicine – Federally Qualified Health Center (FQHC), NPI 1255880647

Illini Family Medicine is a healthcare provider. based in Sauget, Illinois. specializing in Federally Qualified Health Center (FQHC). The NPI Number for Illini Family Medicine is 1255880647

Main info

Organization
Name
Illini Family Medicine
NPI
1255880647
Phone
(618) 332-0953
Address
2041 GOOSE LAKE RD
Authorized Official
MR. LARRY MCCULLEY CEO
Enumeration Date
26 September 2016
Last Update Date
26 September 2016
Data current as of
20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience28
Completeness80
Years active:9State licenses:0Digital endpointsUpdated within 12 months

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Provider Addresses for Illini Family Medicine

  • Goose Lake, Sauget, Saint Clair County, Illinois, 62207, United States

    SAUGET, IL 622062822

    Phone: (618) 332-0953

    Type: Mailing

  • Frank Scott Parkway West, Gartside, Belleville, Saint Clair County, Illinois, 62223, United States

    SUITE 980

    BELLEVILLE, IL 622235000

    Phone: (618) 397-3303

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2016-10-18

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
O20161018001776OFederally Qualified Health Center (Fqhc)ILTBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 62206)

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Reviews

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Frequently asked questions

Can I cross-check Illini Family Medicine using NPI 1255880647?
NPI 1255880647 belongs to Illini Family Medicine; compare other details if you need extra assurance.
Would Illini Family Medicine appear as active to a payer?
You can treat Illini Family Medicine as active for directory purposes; confirm clinical privileges separately.
What kind of doctor is Illini Family Medicine?
Illini Family Medicine is associated with Federally Qualified Health Center (FQHC) in the directory — Clinical services aligned with this taxonomy classification.
What locale is associated with Illini Family Medicine?
Directory geography for Illini Family Medicine centers on Sauget, Illinois.
Does Illini Family Medicine accept insurance?
Insurance participation is not part of the core NPI extract — call the plan or office to confirm.

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