NPIMap

Organization Active NPI

Statera Health Care, LLC

  • Emergency Medicine Physician
  • Harrisburg, IL
National Provider Identifier
1043874449
Registry record updated May 4, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
Legal business name
STATERA HEALTH CARE, LLC
Practice address
100 Dr Warren Tuttle Dr
Harrisburg, IL 62946-2718
Phone
(618) 833-1691
NPI assigned
May 1, 2019
Last updated
May 4, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 4, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Caleb Sutton
Title
Business Operations Manager
Phone
(618) 833-1691

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207P00000X Primary
Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208600000X

Addresses

Primary practice location

100 Dr Warren Tuttle Dr
Harrisburg, IL 62946-2718

Mailing address

2250 N Illinois Ave
Carbondale, IL 62901-5612
Phone (618) 833-1691

Other practice location 1

200 E Fairman Ave
Watseka, IL 60970-1644
Phone (815) 432-5841

Other practice location 2

3333 W DeYoung St
Marion, IL 62959-5884
Phone (618) 998-7000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190708000284 IL Part B Supplier - Clinic/Group Practice 0244565729 Receives reassigned benefits from 176 practitioners
Practice locations: Harrisburg, IL; Marion, IL; MC Leansboro, IL; Metropolis, IL; Mt Vernon, IL; Watseka, IL

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 189

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 189

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1556668800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1683158400000",
    "number": "1043874449",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2250 N ILLINOIS AVE",
            "city": "CARBONDALE",
            "state": "IL",
            "postal_code": "629015612",
            "telephone_number": "618-833-1691",
            "fax_number": "618-861-5302"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 DR WARREN TUTTLE DR",
            "city": "HARRISBURG",
            "state": "IL",
            "postal_code": "629462718",
            "telephone_number": "618-833-1691"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "200 E Fairman Ave",
            "address_purpose": "LOCATION",
            "city": "Watseka",
            "state": "IL",
            "postal_code": "609701644",
            "country_code": "US",
            "telephone_number": "815-432-5841",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3333 W DeYoung St",
            "address_purpose": "LOCATION",
            "city": "Marion",
            "state": "IL",
            "postal_code": "629595884",
            "country_code": "US",
            "telephone_number": "618-998-7000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "STATERA HEALTH CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-05-01",
        "last_updated": "2023-05-04",
        "certification_date": "2023-05-04",
        "status": "A",
        "authorized_official_last_name": "SUTTON",
        "authorized_official_first_name": "CALEB",
        "authorized_official_title_or_position": "BUSINESS OPERATIONS MANAGER",
        "authorized_official_telephone_number": "618-833-1691",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Emergency Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Harrisburg, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.