Active NPI
Sally Jane Muich, NP
- Gerontology Nurse Practitioner
- Belleville, IL
National Provider Identifier
1063515385
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Gerontology Nurse Practitioner
- License
- 209006132
- Practice address
- 180 S 3Rd St
300
Belleville, IL 62220-1952 - Phone
- (618) 233-5480
- Fax
- (618) 222-4972
- NPI assigned
- Sep 6, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Gerontology Registered Nurse | 163WG0600X | 099684 | MO | |
| Gerontology Nurse Practitioner | 363LG0600X | 209006132 | IL | Primary |
Addresses
Primary practice location
180 S 3Rd St
300
Belleville, IL 62220-1952
Mailing address
180 S 3Rd St
300
Belleville, IL 62220-1952
Phone (618) 233-5480
Other names 1
- Sally Jane Muich
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 099684 | MO | MD | Gerontology Registered Nurse |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| David N. Pfohl, MD, LLC | Past | Accepting new patients |
Organizations & group practices 1
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.
-
dba dba ELDERMED SERVICES
- Geriatric Medicine (Internal Medicine) Physician
- O'Fallon, IL
- NPI 1730190018
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1157500800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1354060800000",
"number": "1063515385",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "180 S 3RD ST",
"address_2": "300",
"city": "BELLEVILLE",
"state": "IL",
"postal_code": "622201952",
"telephone_number": "618-233-5480",
"fax_number": "618-222-4972"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "180 S 3RD ST",
"address_2": "300",
"city": "BELLEVILLE",
"state": "IL",
"postal_code": "622201952",
"telephone_number": "618-233-5480",
"fax_number": "618-222-4972"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MUICH",
"first_name": "SALLY",
"middle_name": "JANE",
"name_prefix": "Ms.",
"credential": "NP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-09-06",
"last_updated": "2012-11-28",
"status": "A"
},
"taxonomies": [
{
"code": "163WG0600X",
"taxonomy_group": "",
"desc": "Registered Nurse, Gerontology",
"state": "MO",
"license": "099684",
"primary": false
},
{
"code": "363LG0600X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Gerontology",
"state": "IL",
"license": "209006132",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "SALLY",
"last_name": "MUICH",
"middle_name": "JANE",
"credential": "M.S.N., A.P.R.N.",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Belleville, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 28, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.