OrganizationActive
Fairview Heights Medical Group Sc
NPI 1326171158 · Pediatric Cardiology Physician · Mount Vernon, IL
Provider details
- NPI number
- 1326171158
- Entity type
- Organization
- Primary specialty
- Pediatric Cardiology PhysicianAllopathic & Osteopathic Physicians
- Organization subpart
- No
- Authorized official
- Raymond Davidson, President(314) 286-2028
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Profile Score
Detailed profile(89/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
19 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
4230 Lincolnshire Dr Ste a
Mount Vernon, IL 62864-2189
Phone: (618) 241-1833
Street-level locationGet directions
Mailing address
670 Mason Ridge Center Dr
Saint Louis, MO 63141-8573
Other names (DBA / former)
- Doing business as
- Pediatric Cardiology of Illinois
Registry dates
- Enumerated
- 2007-03-13
- Last updated
- 2008-01-07
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.