Shane Caudill

Primary specialty

Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X

Practice address

2600 W Main St
Belleville, IL 62226-6651

Phone

(618) 239-6109

NPI assigned

Apr 21, 2015

Last updated

Apr 21, 2015By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1429574400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1429574400000",
    "number": "1073900650",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "504 TIMOTHY LN",
            "city": "CARTERVILLE",
            "state": "IL",
            "postal_code": "629185045",
            "telephone_number": "618-521-0078"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2600 W MAIN ST",
            "city": "BELLEVILLE",
            "state": "IL",
            "postal_code": "622266651",
            "telephone_number": "618-239-6109"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CAUDILL",
        "first_name": "SHANE",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-04-21",
        "last_updated": "2015-04-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Anne Margaret Cath, MD
• Catholic Social Service
• Catholic Social Services
• Catholic Social Services of Southern Illinois
• Jennifer Caudell
• CB-Billing
• Center for Oral and Maxillofacial Surgery, P.C.
• Cep America - Illinois SNF, LLP
• Cep America - Illinois SNF, LLP
• Cep America - Illinois SNF, LLP

• Student in an Organized Health Care Education/Training Program in Belleville, IL
• Providers in Belleville, IL by specialty
• Student in an Organized Health Care Education/Training Program in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2015; 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.