Active NPI
Southern Illinois Healthcare Foundation, Inc.
- Federally Qualified Health Center (FQHC)
- Swansea, IL
National Provider Identifier
1063691897
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Federally Qualified Health Center (FQHC)
- Legal business name
- SOUTHERN ILLINOIS HEALTHCARE FOUNDATION, INC.
- Doing business as
- SIHF Healthcare
- Practice address
- 4969 Benchmark Centre Dr Ste 100
Swansea, IL 62226-8928 - Phone
- (618) 235-2311
- NPI assigned
- Oct 29, 2007
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. Larry McCulley
- Title
- President/Ceo
- Phone
- (618) 332-0694
Specialties & licenses 9
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | |||
| Clinical Social Worker | 1041C0700X | |||
| Family Medicine Physician | 207Q00000X | |||
| Pediatrics Physician | 208000000X | |||
| Psychiatry Physician | 2084P0800X | |||
| Federally Qualified Health Center (FQHC) | 261QF0400X | Primary | ||
| Physician Assistant | 363A00000X | |||
| Nurse Practitioner | 363L00000X | |||
| Pediatric Nurse Practitioner | 363LP0200X |
Addresses
Primary practice location
4969 Benchmark Centre Dr Ste 100
Swansea, IL 62226-8928
Mailing address
2041 Goose Lake Rd
Sauget, IL 62206-2822
Phone (618) 332-0953
Other names 2
- SIHF Healthcare
- SIHF Healthcare - Childcare Physicians
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031126000641 | IL | Part B Supplier - Clinic/Group Practice | 1456256874 |
Receives reassigned benefits from 170 practitioners This NPI is an additional NPI on the enrollment Practice locations: East Saint Louis, IL; Effingham, IL; Fairmont City, IL; Glen Carbon, IL; Granite City, IL; Greenup, IL; Mattoon, IL; Millstadt, IL… |
National Provider Directory
National Provider DirectoryLocations
4969 Benchmark Centre Dr
Ste 1
Swansea, IL 62226
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1193616000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1709251200000",
"number": "1063691897",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2041 GOOSE LAKE RD",
"city": "SAUGET",
"state": "IL",
"postal_code": "622062822",
"telephone_number": "618-332-0953",
"fax_number": "618-332-2487"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4969 BENCHMARK CENTRE DR STE 100",
"city": "SWANSEA",
"state": "IL",
"postal_code": "622268928",
"telephone_number": "618-235-2311"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "SOUTHERN ILLINOIS HEALTHCARE FOUNDATION, INC.",
"organizational_subpart": "NO",
"enumeration_date": "2007-10-29",
"last_updated": "2024-03-01",
"certification_date": "2024-03-01",
"status": "A",
"authorized_official_last_name": "MCCULLEY",
"authorized_official_first_name": "LARRY",
"authorized_official_title_or_position": "PRESIDENT/CEO",
"authorized_official_telephone_number": "618-332-0694",
"authorized_official_name_prefix": "Mr."
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Counselor, Professional",
"state": null,
"license": null,
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Social Worker, Clinical",
"state": null,
"license": null,
"primary": false
},
{
"code": "207Q00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Family Medicine",
"state": null,
"license": null,
"primary": false
},
{
"code": "208000000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Pediatrics",
"state": null,
"license": null,
"primary": false
},
{
"code": "2084P0800X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": null,
"license": null,
"primary": false
},
{
"code": "261QF0400X",
"taxonomy_group": "",
"desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
"state": null,
"license": null,
"primary": true
},
{
"code": "363A00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Physician Assistant",
"state": null,
"license": null,
"primary": false
},
{
"code": "363L00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Nurse Practitioner",
"state": null,
"license": null,
"primary": false
},
{
"code": "363LP0200X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Nurse Practitioner, Pediatrics",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "SIHF Healthcare",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "SIHF Healthcare - Childcare Physicians",
"code": "5",
"type": "Other Name"
}
]
}
Other providers in Swansea, IL
- Caroline Smith, LPC
- Jacqueline Smith
- Rosalyn I Smith, D.D.S.
- Kristin Nicole Solovitz, MSPT
- Southern Illinois Caring Hands
- Southern Illinois Healthcare Foundation, Inc.
- Southwest Illinois Health Services, LLP
- Southwest Illinois Health Services, LLP
- Southwestern Illinois Visiting Nurse Association
- Specialists in OB GYN, LTD.
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2024; 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.