George Sun, MD

Primary specialty

Gynecology PhysicianTaxonomy code 207VG0400X

Practice address

430 N Pleasant Ave
Centralia, IL 62801-3006

Phone

(618) 436-8350

Fax

(618) 532-9347

NPI assigned

Jun 5, 2006

Last updated

Nov 27, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

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

• Physician Services Corporation of Southern Illinois Inc.

  dba SSM Health Medical Group

  • Internal Medicine Physician
  • Mount Vernon, IL
  • NPI 1831101807
  NPD (past)

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

{
    "created_epoch": "1149465600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1196121600000",
    "number": "1053350173",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "430 N PLEASANT AVE",
            "city": "CENTRALIA",
            "state": "IL",
            "postal_code": "628013006",
            "telephone_number": "618-436-8350",
            "fax_number": "618-532-9347"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "430 N PLEASANT AVE",
            "city": "CENTRALIA",
            "state": "IL",
            "postal_code": "628013006",
            "telephone_number": "618-436-8350",
            "fax_number": "618-532-9347"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUN",
        "first_name": "GEORGE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-05",
        "last_updated": "2007-11-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207VG0400X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Gynecology",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE NUMBER",
            "identifier": "P00180554",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP",
            "identifier": "207988",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR GROUP NUMBER",
            "identifier": "CH4443",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Heather Stover
• Linda S Stover, MSED LCPC
• Bradley C Stufflebam, M.D.
• Wendy Suey
• Erica L Summers
• Suresh Krishnamoorthy MD SC
• Scott Allen Tate, PT
• Michael Taylor, LPHA, LCPC, CRC
• Terry Chiropractic Clinic, LTD
• Mark W Terry, DC

• Gynecology Physician in Centralia, IL
• Providers in Centralia, IL by specialty
• Gynecology Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.