SIU PHYSICIANS & SURGEONS, INC (NPI# 1790705507) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1790705507 |
| Entity Type | Organization |
| Organization Name | SIU PHYSICIANS & SURGEONS, INC |
| Practice Address |
720 N Bond St Springfield IL 62702-4952 |
| Mailing Address |
Po Box 19639 Springfield IL 62794-9639 |
| Practice Telephone | 2175458000 |
| Mailing Telephone | 2175457578 |
| Mailing Fax Number | 2175451884 |
| Enumeration Date | 2006-07-21 |
| Last Update Date | 2019-06-17 |
| Authorized Official Name | JERRY KRUSE (CEO) |
| Authorized Official Telephone | 2175457876 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207X00000X | Orthopaedic Surgery | ========= | IL | Allopathic & Osteopathic Physicians |
| N | 207XP3100X |
Orthopaedic Surgery Specialization: Pediatric Orthopaedic Surgery |
========= | IL | Allopathic & Osteopathic Physicians |
| N | 207Y00000X | Otolaryngology | ========= | IL | Allopathic & Osteopathic Physicians |
| N | 208600000X | Surgery | ========= | IL | Allopathic & Osteopathic Physicians |
| N | 2086S0120X |
Surgery Specialization: Pediatric Surgery |
========= | IL | Allopathic & Osteopathic Physicians |
| N | 2086S0122X |
Surgery Specialization: Plastic and Reconstructive Surgery |
========= | IL | Allopathic & Osteopathic Physicians |
| N | 208800000X | Urology | ========= | IL | Allopathic & Osteopathic Physicians |
| N | 2088P0231X |
Urology Specialization: Pediatric Urology |
========= | IL | Allopathic & Osteopathic Physicians |
| N | 208C00000X | Colon & Rectal Surgery | ========= | IL | Allopathic & Osteopathic Physicians |
| Y | 207T00000X | Neurological Surgery | ========= | IL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | RR MEDICARE | CE8688 | 01 |
| IL | RR MEDICARE | CE8689 | 01 |
| IL | RR MEDICARE | CB2589 | 01 |
| IL | RR MEDICARE | CE8931 | 01 |
| IL | RR MEDICARE | CE8686 | 01 |
| IL | RR MEDICARE | CE8687 | 01 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 701 N 1st St, D235, Springfield, IL 627023757 | 2175457578 | 2175451884 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558385989 | Siu Physicians & Surgeons, Inc | Dermatology | 201 E Madison St Ste 300, Springfield, IL 62702-5131 | 2006-07-27 |
| 1164055976 | Siu Physicians & Surgeons, Inc | Durable Medical Equipment & Medical Supplies | 747 N Rutledge St Fl 5, Springfield, IL 62702-6700 | 2020-02-20 |
| 1942849096 | Siu Physicians & Surgeons, Inc | Durable Medical Equipment & Medical Supplies | 720 N Bond St, Springfield, IL 62702-4952 | 2020-01-06 |
| 1396211975 | Siu Physicians & Surgeons, Inc | Case Management | 201 E Madison St Ste 300, Springfield, IL 62702-5131 | 2018-10-22 |
| 1053804443 | Siu Physicians & Surgeons, Inc | Clinic/Center | 610 N Westgate Ave, Jacksonville, IL 62650-1152 | 2018-06-11 |
| 1457807869 | Siu Physicians & Surgeons, Inc | Clinic/Center | 608 S Main St, Anna, IL 62906-1247 | 2016-08-27 |
| 1871882787 | Siu Physicians & Surgeons, Inc | Internal Medicine | 315 W Carpenter St, Springfield, IL 62702-4901 | 2011-03-31 |
| 1821290057 | Siu Physicians & Surgeons, Inc | Durable Medical Equipment & Medical Supplies | 747 N Rutledge St, 3rd Floor, Springfield, IL 62702-6700 | 2007-06-01 |
| 1093739435 | Siu Physicians & Surgeons, Inc | Family Medicine | 701 N 1st St, D235, Springfield, IL 62781-0001 | 2006-07-27 |
| 1467476895 | Siu Physicians & Surgeons, Inc | Counselor | 701 N 1st St, D235, Springfield, IL 62781-0001 | 2006-07-27 |
| Street Address |
720 N BOND ST |
| City | SPRINGFIELD |
| State | IL |
| Zip Code | 62702-4952 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528680964 | Noor-e-seher Ali | Otolaryngology | 720 N Bond St, Springfield, IL 62702-4952 | 2020-05-08 |
| 1477175982 | Jillian Michelle Bleck | Otolaryngology | 720 N Bond St, Springfield, IL 62702-4952 | 2020-05-07 |
| 1942849096 | Siu Physicians & Surgeons, Inc | Durable Medical Equipment & Medical Supplies | 720 N Bond St, Springfield, IL 62702-4952 | 2020-01-06 |
| 1750926077 | Amanda Joann Mcdannald | Nurse Practitioner | 720 N Bond St, Springfield, IL 62702-4952 | 2019-11-11 |
| 1871152397 | Spencer Dane Uetz | Otolaryngology | 720 N Bond St, Springfield, IL 62702-4952 | 2019-06-08 |
| 1265917371 | Evans M Mutua | Nurse Practitioner | 720 N Bond St, Springfield, IL 62702-4952 | 2018-09-25 |
| 1467947366 | Guillermo Maza Malave | Otolaryngology | 720 N Bond St, Springfield, IL 62702-4952 | 2018-06-25 |
| 1295227783 | Mitchell Louis Heuermann | Otolaryngology | 720 N Bond St, Springfield, IL 62702 | 2018-05-31 |
| 1336304856 | Arun Sharma | Otolaryngology | 720 N Bond St, Springfield, IL 62702-4952 | 2008-07-24 |
| 1932361169 | Pardis Javadi | Otolaryngology | 720 N Bond St, Springfield, IL 62702-4952 | 2008-06-29 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457866519 | Mohammad Jamal Uddin Ansari | Internal Medicine | 751 N Rutledge St Ste 400, Springfield, IL 62702 | 2017-12-11 |
| 1588105811 | Mickey Graphia | Surgery | 701 N 1st St # D346, Springfield, IL 62702 | 2017-03-20 |
| 1376908913 | Abdul Hannan | Internal Medicine | 315 W Carpenter St # B, Springfield, IL 62702 | 2015-12-28 |
| 1871986414 | Rachel Hoselton | Nurse Practitioner | 400 N 9th St Fl 4, Springfield, IL 62702 | 2015-03-06 |
| 1548697774 | Alyssa Wilson | Behavioral Analyst | 232 Bruns Lane, One Sparcenter Plaza, Springfield, IL 62702 | 2013-10-02 |
| 1174965446 | Amy Wilson | Speech-Language Pathologist | 2120 West Washington Street, Springfield, IL 62702 | 2013-07-26 |
| 1275898116 | Pele Boutrous Dina | Pediatrics | 415 N 9th St # 4w16, Springfield, IL 62702 | 2012-07-06 |
| 1427327733 | Brook D Croke | Genetic Counselor, MS | 400 N. 9th Street, 3rd Floor Clinic B, Springfield, IL 62702 | 2011-12-16 |
| 1629352604 | Renae M Sanchez | Pharmacist | 3216 East Clearlake Ave, Springfield, IL 62702 | 2011-10-07 |
| 1982915302 | William Leland Zelkovich | Radiology | 701 N 1st, Springfield, IL 62702 | 2010-06-30 |
| Find all providers in zip 62702 | ||||
| Taxonomy Code | 207T00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Neurological Surgery |
| A neurological surgeon provides the operative and non-operative management (i.e., prevention, diagnosis, evaluation, treatment, critical care, and rehabilitation) of disorders of the central, peripheral, and autonomic nervous systems, including their supporting structures and vascular supply; the evaluation and treatment of pathological processes which modify function or activity of the nervous system; and the operative and non-operative management of pain. A neurological surgeon treats patients with disorders of the nervous system; disorders of the brain, meninges, skull, and their blood supply, including the extracranial carotid and vertebral arteries; disorders of the pituitary gland; disorders of the spinal cord, meninges, and vertebral column, including those which may require treatment by spinal fusion or instrumentation; and disorders of the cranial and spinal nerves throughout their distribution. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added] Additional Resources: American Board of Neurological Surgery, 2007. http://www.abns.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Neurological Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871114371 | Justin Michael | Neurological Surgery | 701 N 1st St Ste D-319, Springfield, IL 62702-3757 | 2020-05-06 |
| 1023678638 | Matthew Weber | Neurological Surgery | 701 N 1st St, Suite D-319, Springfield, IL 61702 | 2019-06-17 |
| 1194080010 | Scott B Raymond | Neurological Surgery | 2 Medical Center Dr Ste 503, Springfield, MA 01107-1273 | 2012-07-06 |
| 1396988051 | Kevin J Mansfield | Neurological Surgery | 1229 E Seminole St Ste 220, Springfield, MO 65804 | 2009-04-10 |
| 1881853158 | Mayur Jayarao | Neurological Surgery | 3801 S National Ave Ste 700, Springfield, MO 65807 | 2008-06-03 |
| 1164691358 | Donald Hall Pearson | Neurological Surgery | 5116 Eagle Rdg, Springfield, IL 62711-7811 | 2008-02-21 |
| 1750301875 | Jeffrey W. Cozzens | Neurological Surgery | 751 N Rutledge St Fl 3, Springfield, IL 62702-4968 | 2006-07-20 |
| 1972537132 | Alan M. Scarrow | Neurological Surgery | 1965 S Fremont Ave Ste 130, Springfield, MO 65804-2252 | 2006-07-11 |
| 1780628719 | Andrew J Kokkino | Neurological Surgery | 3377 Riverbend Dr Fl 5, Springfield, OR 97477-8803 | 2006-06-16 |
| 1134613961 | Nathan Nordmann | Neurological Surgery | 701 N 1st St, Springfield, IL 62702-3757 | 2018-06-15 |
| Find all providers in SPRINGFIELD | ||||
| City | SPRINGFIELD |
| Zip Code | 62702 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.