Regency Park Medical Group LLC
NPI 1063034783 · General Practice Physician · O Fallon, IL
Enrolled with Medicare as Part B Supplier - Clinic/Group Practice · source: CMS PECOS Public Provider Enrollment (2026.04.01)
Regency Park Medical Group LLC is a General Practice Physician organization in O Fallon, IL (NPI 1063034783).
Provider details
- NPI number
- 1063034783
- 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
- 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
- Family Nurse Practitioner363LF0000X
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
- 2021-08-19
- Certified
- 2021-08-19
Frequently asked questions
- What is Regency Park Medical Group LLC's NPI number?
- Regency Park Medical Group LLC's National Provider Identifier (NPI) is 1063034783, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What type of organization is Regency Park Medical Group LLC?
- Regency Park Medical Group LLC is classified in the NPPES registry as General Practice Physician (Allopathic & Osteopathic Physicians).
- Where is Regency Park Medical Group LLC located?
- Regency Park Medical Group LLC's practice location on file with NPPES is 124 Regency Park Ste 7, O Fallon, IL 62269-1994.
- What is Regency Park Medical Group LLC's phone number?
- The practice phone number listed in the NPPES registry for Regency Park Medical Group LLC is (480) 926-7800.
- Does Regency Park Medical Group LLC accept Medicare?
- Regency Park Medical Group LLC is approved to bill Medicare according to CMS PECOS enrollment data (2026.04.01). Confirm current participation with the provider before scheduling.
- Who is the authorized official for Regency Park Medical Group LLC?
- The authorized official listed on Regency Park Medical Group LLC's NPPES record is Ellie Descalzo, Credentialing Officer. The authorized official registers and maintains the organization's NPI and is not necessarily its owner.
- Is Regency Park Medical Group LLC's NPI active?
- Yes — Regency Park Medical Group LLC's NPI (1063034783) is active in the NPPES registry as of the last update on 2021-08-19.
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.