OrganizationActive
Deaconess Illinois Clinic, Inc
NPI 1114644747 · Family Medicine Physician · Mount Vernon, IL
Provider details
- NPI number
- 1114644747
- Entity type
- Organization
- Primary specialty
- Family Medicine PhysicianAllopathic & Osteopathic Physicians
- Organization subpart
- No
- Authorized official
- Kyle Dillman, Secretary / Treasurer(812) 450-7399
Specialties & taxonomies
Allopathic & Osteopathic Physicians
- Orthopaedic Surgery Physician207X00000X
Allopathic & Osteopathic Physicians
- Physician Assistant363A00000X
Physician Assistants & Advanced Practice Nursing Providers
Profile Score
Established profile(59/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
3 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
4113 S Water Tower Pl
Mount Vernon, IL 62864-6293
Phone: (618) 241-9071
Fax: (618) 241-9079
Street-level locationGet directions
Mailing address
Po Box 34156
Belfast, ME 04915-0619
Other names (DBA / former)
- Doing business as
- Deaconess Illinois Clinic
- Doing business as
- Deaconess Illinois Clinic
Registry dates
- Enumerated
- 2022-10-25
- Last updated
- 2022-12-02
- Certified
- 2022-12-02
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.