Main Street Medical Group LLC
NPI 1043832769 · General Practice Physician · O Fallon, IL
Provider details
- NPI number
- 1043832769
- Entity type
- Organization
- Primary specialty
- General Practice PhysicianAllopathic & Osteopathic Physicians
- Organization subpart
- No
- Authorized official
- Ellie Descalzo, Credentialing Officer(480) 926-7800
Specialties & taxonomies
Allopathic & Osteopathic Physicians
- Family Nurse Practitioner363LF0000X
Physician Assistants & Advanced Practice Nursing Providers
- Chiropractor111N00000X
Chiropractic Providers
- Internal Medicine Physician207R00000X
Allopathic & Osteopathic Physicians
- Physical Therapist225100000X
Respiratory, Developmental, Rehabilitative and Restorative Service Providers
- Physician Assistant363A00000X
Physician Assistants & Advanced Practice Nursing Providers
Profile Score
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
6 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
Mailing address
Registry dates
- Enumerated
- 2020-05-15
- Last updated
- 2021-05-04
- Certified
- 2021-05-04
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.