MEDICARE: NOLASCO MEDICAL GROUP, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	207RH0005X	Hypertension Specialist Physician
2	2084P0800X	Psychiatry Physician
3	2084P0804X	Child & Adolescent Psychiatry Physician
4	261QP2300X	Primary Care Clinic/Center
5	207R00000X	Internal Medicine Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	F100698048	OTHER	IL	MEDICARE PTAN

General Provider Information

NPI Number	:	1184235905
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NOLASCO MEDICAL GROUP, PLLC

Provider Business Mailing Address
First Line	:	2317 S BATES AVE
Second Line	:
City	:	SPRINGFIELD
State	:	IL
Zip	:	62704-4337
Country	:	US
Telephone Number	:	866-477-7472
Fax Number	:	217-717-2268

Provider Business Practice Location Address
First Line	:	2317 S BATES AVE
Second Line	:
City	:	SPRINGFIELD
State	:	IL
Zip	:	62704-4337
Country	:	US
Telephone Number	:	866-477-7472
Fax Number	:	217-717-2268

Authorized Official
Title or Position	:	PRESIDENT AND CEO
Name	:	DR. CARLOS ERNESTO NOLASCO MORALES
Credential	:	M.D.
Telephone Number	:	866-477-7472

Provider Enumeration Date	:	08/14/2020
Last Update Date	:	12/01/2020

Similar Medicare Providers

1467527317 — DR. MICHAEL B HALLE MD
Practice Location Address:

2101 E JEFFERSON ST , KAISER PERMANENTE SPRINGFIELD MEDICARE ENROLLMENT
ROCKVILLE, MD
20852-4908

Practice Phone: 701-922-1000
Practice Fax: 703-922-1039

1235484866 — DR. CARLOS ERNESTO NOLASCO MORALES M.D.
Practice Location Address:

2317 S BATES AVE
SPRINGFIELD, IL
62704-4337

Practice Phone: 866-477-7472
Practice Fax: 217-717-2268

1033638275 — STEPHEN DOUGLAS BOWMAN
Practice Location Address:

1115 FARLOW ST
SPRINGFIELD, OH
45503-4337

Practice Phone: 937-536-2764
Practice Fax:

1598745010 — DR. BALAJI PADMANABAN ATHREYA M.D
Practice Location Address:

100 WASON AVE , SUITE 200
SPRINGFIELD, MA
01107-1381

Practice Phone: 413-733-9666
Practice Fax: 413-750-3432

1619921806 — DR. MOHAMMED S AKRAM MD, MHA
Practice Location Address:

102 W KENWOOD AVE
DECATUR, IL
62526-4368

Practice Phone: 217-545-8000
Practice Fax:

1164450987 — JOHN MARK FLACK MD, MPH
Practice Location Address:

751 N RUTLEDGE ST , SUITE 1100
SPRINGFIELD, IL
62702-4968

Practice Phone: 217-545-8000
Practice Fax: 217-545-4735

Directions to “NOLASCO MEDICAL GROUP, PLLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.