Active NPI
Matthew Tolman Stedelin, M.D.
- Pediatrics Physician
- Centralia, IL
National Provider Identifier
1043218837
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- Practice address
- 130 S Lincoln Blvd
Centralia, IL 62801-3654 - Phone
- (618) 532-3604
- Fax
- (618) 532-2952
- NPI assigned
- Jul 14, 2005
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | IL | Primary |
Addresses
Primary practice location
130 S Lincoln Blvd
Centralia, IL 62801-3654
Mailing address
130 S Lincoln Blvd
Centralia, IL 62801-3654
Phone (618) 532-3604
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20130415000251 | IL | Order and Referring Only - Pediatric Medicine | 7618113861 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Pediatric Group LLC | Pediatrics | Past | Accepting new patients |
| Pediatric Group LLC | Pediatrics | Past | Accepting new patients |
Interoperability endpoints
- https://api.platform.athenahealth.com/11869/brand/1/csg/1/fhir/r4
- matthew.stedelin.1@11869.direct.athenahealth.com
Organizations & group practices 2
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1121299200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1043218837",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "130 S LINCOLN BLVD",
"city": "CENTRALIA",
"state": "IL",
"postal_code": "628013654",
"telephone_number": "618-532-3604",
"fax_number": "618-532-2952"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "130 S LINCOLN BLVD",
"city": "CENTRALIA",
"state": "IL",
"postal_code": "628013654",
"telephone_number": "618-532-3604",
"fax_number": "618-532-2952"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STEDELIN",
"first_name": "MATTHEW",
"middle_name": "TOLMAN",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-07-14",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "IL",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Centralia, IL
- St. Mary's Hospital, Centralia, Illinois (SSM Health St. Mary's Hospital - Centralia)
- St. Mary's Hospital, Centralia, Illinois (SSM Health St. Mary's Hospital - Centralia)
- St. Mary's Hospital, Centralia, Illinois (SSM Health St. Mary's Hospital - Centralia)
- St. Marys Good Samaritan Inc
- Katelyn Starr, PHARM D
- Julia Steinkamp, OTR/L
- Stephen T Ang MD SC
- Sthomas Sehy DPM LLC (Page Foot and Ankle)
- Megan Elizabeth Stinnett
- Rex Stombaugh, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.