Millstadt Medical Clinic – Federally Qualified Health Center (FQHC), NPI 1811236458

Millstadt Medical Clinic is a healthcare provider. based in Sauget, Illinois. specializing in Federally Qualified Health Center (FQHC). The NPI Number for Millstadt Medical Clinic is 1811236458

Main info

Organization
Name
Millstadt Medical Clinic
NPI
1811236458
Phone
(618) 332-0953
Address
2041 GOOSE LAKE RD
Authorized Official
LARRY MCCULLEY CEO
Enumeration Date
1 February 2013
Last Update Date
1 February 2013
Data current as of
20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience36
Completeness80
Years active:13State licenses:0Digital endpointsUpdated within 12 months

Provider Addresses for Millstadt Medical Clinic

  • 2041 GOOSE LAKE RD

    SAUGET, IL 622062822

    Phone: (618) 332-0953

    Fax: (618) 332-2487

    Type: Mailing

  • 60 REGENCY PL

    MILLSTADT, IL 622602210

    Phone: (618) 476-9177

    Fax: (618) 476-1890

    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: 2013-03-08

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Past revalidation due date

Earliest CMS due date was 2026-04-30 (41 days ago).

Enrollment records

1

Earliest due date

2026-04-30

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
O20130308000481OFederally Qualified Health Center (Fqhc)IL2026-04-30

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.

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

Where can patients find Millstadt Medical Clinic's NPI?
You can confirm Millstadt Medical Clinic with NPI 1811236458; it appears in the national provider directory.
Is Millstadt Medical Clinic's enrollment marked active?
An active flag here means the NPI record is not in a deactivated state.
What kind of provider is Millstadt Medical Clinic?
The page reflects Federally Qualified Health Center (FQHC) for Millstadt Medical Clinic. Clinical services aligned with this taxonomy classification.
Does Millstadt Medical Clinic practice in Illinois?
You will see Sauget, Illinois on file for Millstadt Medical Clinic alongside any extra practice locations.
Does Medicare enrollment show here?
Medicare enrollment screens are separate from the basic NPI extract shown here.

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