Active NPI
John R Sellett, MD
- Family Medicine Physician
- Champaign, IL
National Provider Identifier
1093815342
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 036081168
- Practice address
- 1701 W Curtis Road
Family Medicine/Convenient Care
Champaign, IL 61822 - Phone
- (217) 365-6201
- Fax
- (217) 326-1234
- NPI assigned
- Sep 25, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 036081168 | IL | Primary |
Addresses
Primary practice location
1701 W Curtis Road
Family Medicine/Convenient Care
Champaign, IL 61822
Mailing address
611 W. Park. St.
BWPC
Urbana, IL 61801-2500
Phone (217) 383-6792
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0533210001 | Other | IL | DMERC |
| 080043875 | Other | IL | RAILROAD |
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
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036081168 | IL | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159142400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1399852800000",
"number": "1093815342",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "611 W. PARK. ST.",
"address_2": "BWPC",
"city": "URBANA",
"state": "IL",
"postal_code": "618012500",
"telephone_number": "217-383-6792",
"fax_number": "217-383-4752"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1701 W CURTIS ROAD",
"address_2": "FAMILY MEDICINE/CONVENIENT CARE",
"city": "CHAMPAIGN",
"state": "IL",
"postal_code": "61822",
"telephone_number": "217-365-6201",
"fax_number": "217-326-1234"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SELLETT",
"first_name": "JOHN",
"middle_name": "R",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-25",
"last_updated": "2014-05-12",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "IL",
"license": "036081168",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DMERC",
"identifier": "0533210001",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD",
"identifier": "080043875",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Champaign, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.