NPIMap

Individual provider Active NPI

Terakeith Lertsburapa, MD

  • Anatomic Pathology & Clinical Pathology Physician
  • Mattoon, IL
National Provider Identifier
1033360706
Registry record updated Aug 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
License
036152556 Issued in IL
Practice address
1000 Health Center Dr
Mattoon, IL 61938-4644
Phone
(217) 258-2247
Fax
(217) 238-4584
NPI assigned
Sep 30, 2008
Sex
Male
Sole proprietor
No

Organizations & group practices 21

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

View all 21

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

Care Compare profile

Medicare Care Compare
Specialty
Pathology
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sarah Bush Lincoln Health Center 411 clinicians
Crawford Hospital District 71 clinicians

Practice addresses (Care Compare)

1000 Health Ctr Dr
Mattoon, IL 61938-4644
Phone (217) 258-2525

1000 N Allen St
Robinson, IL 62454-1114
Phone (618) 546-5600

Hospital & facility affiliations

  • Sarah Bush Lincoln Health Center Hospital, Mattoon, IL, CCN 140189
  • Crawford Memorial Hospital Hospital, Robinson, IL, CCN 141343

Merit-based Incentive Payment System (MIPS)

Final score
88.96 of 100Reported as apm
Quality
69.5
Promoting interoperability
100
Improvement activities
40

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240909001509 IL Practitioner - Pathology 8224491170 Reassigns benefits to 3 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
036152556ILMDAnatomic Pathology & Clinical Pathology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Sarah Bush Lincoln Health Center CurrentSince Sep 3, 2024 Accepting new patients
Crawford Hospital District CurrentSince Sep 1, 2024 Accepting new patients
Sarah Bush Lincoln Health Center CurrentSince Sep 3, 2024 Accepting new patients
Crawford Hospital District CurrentSince Sep 1, 2024 Accepting new patients
Crawford Hospital District Current Accepting new patients
Salem Township Hospital Past Accepting new patients

Locations

1000 Health Center Dr
Mattoon, IL 61938
Phone (217) 258-2389

101 Professional Plz
Mattoon, IL 61938
Phone (217) 238-3730

1000 N Allen St
Robinson, IL 62454
Phone (618) 544-3131

650 W Taylor St
Vandalia, IL 62471
Phone (618) 283-1231

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X 036152556 IL Primary

Addresses

NPPES NPI Registry

Primary practice location

1000 Health Center Dr
Mattoon, IL 61938-4644

Mailing address

PO Box 372
Mattoon, IL 61938-0372

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Aug 26, 2024.

{
    "created_epoch": "1222732800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724630400000",
    "number": "1033360706",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 372",
            "city": "MATTOON",
            "state": "IL",
            "postal_code": "619380372"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 HEALTH CENTER DR",
            "city": "MATTOON",
            "state": "IL",
            "postal_code": "619384644",
            "telephone_number": "217-258-2247",
            "fax_number": "217-238-4584"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LERTSBURAPA",
        "first_name": "TERAKEITH",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-09-30",
        "last_updated": "2024-08-26",
        "certification_date": "2024-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "IL",
            "license": "036152556",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mattoon, IL

Sources for this page

Verify at the official NPI Registry.