Organization Active NPI

VSR PLLC

  • Internal Medicine Physician
  • Decatur, IL
National Provider Identifier
1104510650
Registry record updated Jun 20, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
VSR PLLC
Practice address
180 W Imboden Dr
Decatur, IL 62521-5238
Phone
(715) 207-1134
NPI assigned
Jun 7, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 20, 2023

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

Authorized official

Name
Venu M Rangu, MD
Title
President
Phone
(715) 387-9055

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X Primary
Hospitalist PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208M00000X

Addresses

Primary practice location

180 W Imboden Dr
Decatur, IL 62521-5238

Mailing address

4200 Conestoga Dr Ste 102
PO Box 178
Springfield, IL 62711-7937
Phone (715) 207-1134

Other practice location 1

1790 S Fairview Ave
Decatur, IL 62521-4010
Phone (715) 207-1134

Other practice location 2

500 W McKinley Ave
Decatur, IL 62526-3281
Phone (715) 207-1134

Other practice location 3

565 W Marion Ave
Forsyth, IL 62535-2099
Phone (715) 207-1134

Other identifiers 1

IdentifierTypeStateIssuer
F100973628OtherILMEDICARE PTAN

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1686096000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1687219200000",
    "number": "1104510650",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4200 CONESTOGA DR STE 102",
            "address_2": "PO BOX 178",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627117937",
            "telephone_number": "715-207-1134"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "180 W IMBODEN DR",
            "city": "DECATUR",
            "state": "IL",
            "postal_code": "625215238",
            "telephone_number": "715-207-1134"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1790 S Fairview Ave",
            "address_purpose": "LOCATION",
            "city": "Decatur",
            "state": "IL",
            "postal_code": "625214010",
            "country_code": "US",
            "telephone_number": "715-207-1134",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "500 W McKinley Ave",
            "address_purpose": "LOCATION",
            "city": "Decatur",
            "state": "IL",
            "postal_code": "625263281",
            "country_code": "US",
            "telephone_number": "715-207-1134",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "565 W Marion Ave",
            "address_purpose": "LOCATION",
            "city": "Forsyth",
            "state": "IL",
            "postal_code": "625352099",
            "country_code": "US",
            "telephone_number": "715-207-1134",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "VSR PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-06-07",
        "last_updated": "2023-06-20",
        "certification_date": "2023-06-20",
        "status": "A",
        "authorized_official_last_name": "RANGU",
        "authorized_official_first_name": "VENU",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "715-387-9055",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Hospitalist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "F100973628",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Decatur, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 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.