Basic Information
| Provider Information | |||||||||
| NPI: | 1992875090 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TOPIN | ||||||||
| FirstName: | JEREMY | ||||||||
| MiddleName: | D | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 1000 HEALTH CENTER DR | ||||||||
| Address2: | |||||||||
| City: | MATTOON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 619384644 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2172384960 | ||||||||
| FaxNumber: | 2172384951 | ||||||||
| Practice Location | |||||||||
| Address1: | 1000 HEALTH CENTER DR | ||||||||
| Address2: | |||||||||
| City: | MATTOON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 619384644 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2172384960 | ||||||||
| FaxNumber: | 2172384951 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/08/2006 | ||||||||
| LastUpdateDate: | 12/30/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 12/30/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0200X | 036105579 | IL | N | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine | 207RP1001X | 036105579 | IL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
ID Information
| ID | Type | State | Issuer | Description | 100086669 | 05 | WI | MEDICAID | 036105579 | 05 | IL | MEDICAID |