TRINITY MEDICAL STAFFING LLC – Internal Medicine Physician, NPI 1770103426
Internal Medicine Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for TRINITY MEDICAL STAFFING LLC
2250 N ILLINOIS AVE
CARBONDALE, IL 629015612
Phone:
Type: Mailing
28 Chick St
Metropolis, IL 629602467
Phone: (618) 427-2680
Type: Location
8 Doctors Park Rd
Mount Vernon, IL 628646224
Phone: (618) 244-5500
Type: Location
200 E Fairman Ave
Watseka, IL 609701644
Phone: (815) 432-5841
Type: Location
911 Stacey Burk Dr
Flora, IL 628393241
Phone: (618) 662-2131
Type: Location
611 S Marshall Ave
Mc Leansboro, IL 628591213
Phone: (618) 643-2631
Type: Location
400 Maple Summit Rd
Jerseyville, IL 620522028
Phone: (618) 498-6402
Type: Location
100 DR WARREN TUTTLE DR
HARRISBURG, IL 629462718
Phone: (618) 253-7671
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: 2020-05-11
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Past revalidation due date
Earliest CMS due date was 2025-08-31 (281 days ago).
Enrollment records
1
Earliest due date
2025-08-31
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| O20200511000598 | O | Clinic/Group Practice | IL | 2025-08-31 |
What to do next
- Verify current status on the CMS Revalidation Lookup Tool immediately.
- Complete revalidation in PECOS or contact your Medicare Administrative Contractor (MAC).
- Overdue revalidation can lead to deactivation of Medicare billing privileges.
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 62901)
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