Illinois Rural Healthcare

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

ILLINOIS RURAL HEALTHCARE

Practice address

17781 Hornbean Dr
Wildwood, MO 63005-4229

Phone

(312) 953-5636

NPI assigned

Jul 10, 2023

Last updated

Jul 10, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Sarfaraz Jasdanwala, MDNPI 1851646665

Title

Ceo

Phone

(031) 295-3563

Specialties & licenses 2

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Sarfaraz A Jasdanwala, MD

  • Internal Medicine Physician
  • Grand Rapids, MI
  • NPI 1851646665
  NPD Authorized official

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

{
    "created_epoch": "1688947200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1688947200000",
    "number": "1093493041",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1003 HAUCK DR",
            "city": "ROLLA",
            "state": "MO",
            "postal_code": "654012584",
            "telephone_number": "573-466-2056",
            "fax_number": "573-426-3204"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17781 HORNBEAN DR",
            "city": "WILDWOOD",
            "state": "MO",
            "postal_code": "630054229",
            "telephone_number": "312-953-5636"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ILLINOIS RURAL HEALTHCARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-07-10",
        "last_updated": "2023-07-10",
        "certification_date": "2023-07-10",
        "status": "A",
        "authorized_official_last_name": "JASDANWALA",
        "authorized_official_first_name": "SARFARAZ",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "031-295-3563",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207RA0401X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Addiction Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Breanna Henson, BCBA
• Luke Herbst, PA-S
• Melissa Anne Hodge, PT
• Steven Ice, MOT, OT/L, CDRS
• Idim
• In Harmony Music Therapy, LLC (In Harmony Music Therapy Services)
• Susan Lynn Inserra, OTR/L
• Rena A Isenogle, RPH
• Brenda Gail Izen, M.D.
• Eve Jacobs, CNM

• Internal Medicine Physician in Wildwood, MO
• Providers in Wildwood, MO by specialty
• Internal Medicine Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2023; 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.