NPIMap

Individual provider Active NPI

Shane C. Fogo, M.D.

  • Family Medicine Physician
  • Eureka, IL
National Provider Identifier
1063446318
Registry record updated Dec 14, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
036111674 Issued in IL
Practice address
105 S Major St
Eureka, IL 61530-1246
Phone
(309) 467-4691
NPI assigned
Jul 11, 2006
Last updated
Dec 14, 2012By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 14, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 036111674 IL Primary

Addresses

Primary practice location

105 S Major St
Eureka, IL 61530-1246

Mailing address

701 Lee St
Suite 300
Des Plaines, IL 60016-4539
Phone (847) 390-5900

Other identifiers 3

IdentifierTypeStateIssuer
036111674MedicaidIL
10215111OtherILBCBS TCH
5715395OtherILBCBS HPT

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
I20041208000245 IL Practitioner - Family PracticePractitioner - Emergency Medicine 2365408606 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Illinois College of Med (CHI/Peor/Rock/CHM-Urb), 2002
Medicare assignment
May accept Medicare assignment
Group practices
Carle Eureka HospitalGroup PAC ID 3870914393, 10 clinicians

Practice addresses (Care Compare)

101 S Major St
Eureka, IL 61530-1246
Phone (309) 467-2371

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Carle Bromenn Medical Center CurrentSince Dec 26, 2022 Accepting new patients
Carle Health Medical Group Family Medicine CurrentSince Oct 4, 2025 Accepting new patients
Carle Eureka Hospital CurrentSince Oct 9, 2025 Accepting new patients
Carle West Physician Group Inc Family Medicine CurrentSince Jul 1, 2020 Accepting new patients
Advocate Health and Hospitals Corp. CurrentSince Mar 25, 2018 Accepting new patients
Advocate Health and Hospitals Corporation CurrentSince Mar 25, 2018 Accepting new patients
Advocate Health and Hospitals Corporation Current Accepting new patients
Carle Bromenn Medical Center CurrentSince Dec 26, 2022 Accepting new patients
Gibson Community Hospital Association Past Accepting new patients
Carle Eureka Hospital Past Accepting new patients

Locations

2575 W Algonquin Rd
Algonquin, IL 60102
Phone (847) 854-5533

2204 Eastland Dr
Bloomington, IL 61704
Phone (309) 662-9461

595 William R Latham SR Dr
Bourbonnais, IL 60914
Phone (815) 932-8944

135 N Arlington Heights Rd
Buffalo Grove, IL 60089
Phone (847) 215-8866

214 McHenry Rd
Buffalo Grove, IL 60089
Phone (847) 459-1160

2740 W Foster Ave
Ste 101
Chicago, IL 60625
Phone (773) 545-9500

29373 Network Pl
Chicago, IL 60673

385 S Orange St
El Paso, IL 61738
Phone (309) 527-4900

101 S Major St
Eureka, IL 61530
Phone (309) 268-2172

105 S Major St
Eureka, IL 61530
Phone (309) 467-2371

911 S Chestnut St
Le Roy, IL 61752
Phone (309) 365-8608

1300 Franklin Ave
Ste 100
Normal, IL 61761
Phone (309) 268-3503

1302 Franklin Ave
Ste 1100
Normal, IL 61761
Phone (309) 268-2727

1304 Franklin Ave
Normal, IL 61761
Phone (309) 268-3590

1437 E College Ave
Normal, IL 61761
Phone (309) 454-4411

815 Main St
Ste A
Peoria, IL 61602
Phone (309) 671-3000

815 Main St
Ste A1
Peoria, IL 61602

611 W Park St
Urbana, IL 61801
Phone (217) 383-6941

Organizations & group practices 10

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.

Hospital & facility affiliations 10

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

NPI Registry JSON

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

{
    "created_epoch": "1152576000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1355443200000",
    "number": "1063446318",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "701 LEE ST",
            "address_2": "SUITE 300",
            "city": "DES PLAINES",
            "state": "IL",
            "postal_code": "600164539",
            "telephone_number": "847-390-5900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 S MAJOR ST",
            "city": "EUREKA",
            "state": "IL",
            "postal_code": "615301246",
            "telephone_number": "309-467-4691"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FOGO",
        "first_name": "SHANE",
        "middle_name": "C.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-11",
        "last_updated": "2012-12-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036111674",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036111674",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS TCH",
            "identifier": "10215111",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS HPT",
            "identifier": "5715395",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Eureka, IL

Sources for this page

Verify at the official NPI Registry.