NPIMap

Organization Active NPI

Southern Illinois Gi Specialists LLC

  • Gastroenterology Physician
  • Carbondale, IL
National Provider Identifier
1093775405
Registry record updated Aug 12, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
036094155 Issued in IL
Legal business name
SOUTHERN ILLINOIS GI SPECIALISTS LLC
Practice address
1100 W Diann LN
Carbondale, IL 62901-5339
Phone
(618) 549-8006
Fax
(618) 549-8434
NPI assigned
Mar 28, 2006
Last updated
Aug 12, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 12, 2008

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

Authorized official

Name
Zahoor A Makhdoom, MDNPI 1982667309
Title
MD Owner
Phone
(618) 549-8006

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RG0100X 036094155 IL Primary

Addresses

Primary practice location

1100 W Diann LN
Carbondale, IL 62901-5339

Mailing address

PO Box 365
Carbondale, IL 62903-0365
Phone (618) 476-9399

Other identifiers 4

IdentifierTypeStateIssuer
063398OtherHEALTH ALLIANCE HMO
036094155MedicaidIL
03926864OtherILBCBS IL
435384OtherHEALTHLINK

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041203000280 IL Part B Supplier - Clinic/Group Practice 1658337456 Receives reassigned benefits from 6 practitioners
Practice locations: Carbondale, IL

National Provider Directory

National Provider Directory

Locations

1100 W Diann Ln
Carbondale, IL 62901
Phone (618) 549-8006

1111 Cedar Ct
Carbondale, IL 62901
Phone (618) 203-2772

305 W Jackson St
Ste 303
Carbondale, IL 62901
Phone (618) 351-4976

305 W Jackson St
Ste 401
Carbondale, IL 62901

2 S Hospital Dr
Murphysboro, IL 62966
Phone (618) 684-3156

Interoperability endpoints

  • FHIR API: https://fa120b5c-6699-49eb-9b43-fa51a183b3cb.gastro.prod.fhir.ema-api.com/fhir/r4/

Practitioners & affiliated clinicians

Practitioners 34

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.

View all 34

NPI Registry JSON

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

{
    "created_epoch": "1143504000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1218499200000",
    "number": "1093775405",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 365",
            "city": "CARBONDALE",
            "state": "IL",
            "postal_code": "629030365",
            "telephone_number": "618-476-9399",
            "fax_number": "618-476-9547"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 W DIANN LN",
            "city": "CARBONDALE",
            "state": "IL",
            "postal_code": "629015339",
            "telephone_number": "618-549-8006",
            "fax_number": "618-549-8434"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN ILLINOIS GI SPECIALISTS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-28",
        "last_updated": "2008-08-12",
        "status": "A",
        "authorized_official_last_name": "MAKHDOOM",
        "authorized_official_first_name": "ZAHOOR",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "MD OWNER",
        "authorized_official_telephone_number": "618-549-8006",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "IL",
            "license": "036094155",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH ALLIANCE HMO",
            "identifier": "063398",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036094155",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS IL",
            "identifier": "03926864",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHLINK",
            "identifier": "435384",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Carbondale, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2008; 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.

Verify at the official NPI Registry.