Individual provider Active NPI

Scott K Schonewolf, M.D.

  • Family Medicine Physician
  • Carbondale, IL
National Provider Identifier
1114996204
Registry record updated Dec 9, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
036-114842 Issued in IL
Practice address
305 W Jackson St
Suite 200
Carbondale, IL 62901
Phone
(618) 453-3777
Fax
(618) 453-1102
NPI assigned
Mar 14, 2006
Last updated
Dec 9, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 9, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Medicine (Family Medicine) Physician 207QS0010X 036-114842 IL
Family Medicine Physician 207Q00000X 036-114842 IL Primary

Addresses

Primary practice location

305 W Jackson St
Suite 200
Carbondale, IL 62901

Mailing address

300 W Oak St
Carbondale, IL 62901-1400
Phone (618) 536-6621

Other identifiers 1

IdentifierTypeStateIssuer
036114842MedicaidIL

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address scottschonewolf@siusm.allscriptsdirect.net

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060126000776 IL Practitioner - Family Practice 6002882560 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Philadelphia College of Osteopathic Medicine, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

300 W Oak St
Carbondale, IL 62901-1400
Phone (618) 536-6621

520 N 4TH St
Springfield, IL 62702-5238
Phone (217) 545-8000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy, Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
036-114842ILMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Southern Illinois Hospital Services Family Medicine CurrentSince Jan 15, 2018 Accepting new patients
Siu Physicians & Surgeons, Inc CurrentSince Nov 7, 2005 Accepting new patients
Board of Trustees of Southern Illinois University Current Accepting new patients
Board of Trustees of Southern Illinois University Family Medicine CurrentSince Oct 28, 2020 Accepting new patients
Southern Illinois Hospital Services Current Accepting new patients
Siu Physicians & Surgeons, Inc Family Medicine CurrentSince Nov 7, 2005 Accepting new patients
Board of Trustees of Southern Illinois University CurrentSince Oct 28, 2020 Accepting new patients
Southern Illinois Hospital Services CurrentSince Jan 15, 2018 Accepting new patients

Locations

305 W Jackson St
Ste 200
Carbondale, IL 62901
Phone (618) 453-3777

520 N 4th St
Springfield, IL 62702
Phone (217) 757-8100

751 N Rutledge St
Springfield, IL 62702
Phone (217) 545-0182

2553 Ken Gray Blvd
West Frankfort, IL 62896
Phone (618) 932-2155

Interoperability endpoints

  • Direct secure messaging: scottschonewolf@siusm.allscriptsdirect.net

Organizations & group practices 8

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1142294400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1607472000000",
    "number": "1114996204",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 W OAK ST",
            "city": "CARBONDALE",
            "state": "IL",
            "postal_code": "629011400",
            "telephone_number": "618-536-6621"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "305 W JACKSON ST",
            "address_2": "SUITE 200",
            "city": "CARBONDALE",
            "state": "IL",
            "postal_code": "62901",
            "telephone_number": "618-453-3777",
            "fax_number": "618-453-1102"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SCHONEWOLF",
        "first_name": "SCOTT",
        "middle_name": "K",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-14",
        "last_updated": "2020-12-09",
        "certification_date": "2020-12-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207QS0010X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sports Medicine",
            "state": "IL",
            "license": "036-114842",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036-114842",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036114842",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "scottschonewolf@siusm.allscriptsdirect.net",
            "affiliation": "N",
            "address_1": "305 W Jackson St",
            "address_2": "SUITE 200",
            "city": "Carbondale",
            "state": "IL",
            "country_code": "US",
            "postal_code": "62901",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Carbondale, IL

Sources for this page

Verify at the official NPI Registry.