NPIMap

Organization Active NPI

Southern Illinois Consultants for Kidney Disease, S.C.

  • Specialist
  • Mount Vernon, IL
National Provider Identifier
1144283300
Registry record updated Jan 27, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
060-007470 Issued in IL
Legal business name
SOUTHERN ILLINOIS CONSULTANTS FOR KIDNEY DISEASE, S.C.
Practice address
416 N 12TH St
Mount Vernon, IL 62864-4314
Phone
(618) 244-4850
Fax
(618) 244-7985
NPI assigned
Apr 10, 2006
Last updated
Jan 27, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 27, 2012

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

Authorized official

Name
Dr. Steven J. Zelman, M.D.NPI 1487618765
Title
C.E.O.
Phone
(618) 244-4850

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X 060-007470 IL Primary

Addresses

Primary practice location

416 N 12TH St
Mount Vernon, IL 62864-4314

Mailing address

PO Box 1704
Mount Vernon, IL 62864-0034
Phone (618) 244-4850

Other identifiers 2

IdentifierTypeStateIssuer
3523854003MedicaidIL
4123105OtherBLUE CROSS BLUE SHIELD

National Provider Directory

National Provider Directory

Locations

1151 Route 14 W
Benton, IL 62812
Phone (618) 435-4850

500 N Du Quoin St
Benton, IL 62812
Phone (618) 244-4850

1231 State Route 161
Centralia, IL 62801
Phone (618) 532-5030

416 N 12th St
Mount Vernon, IL 62864
Phone (618) 244-4850

Practitioners & affiliated clinicians

Practitioners 7

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.

NPI Registry JSON

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

{
    "created_epoch": "1144627200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1327622400000",
    "number": "1144283300",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1704",
            "city": "MOUNT VERNON",
            "state": "IL",
            "postal_code": "628640034",
            "telephone_number": "618-244-4850",
            "fax_number": "618-244-7985"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "416 N 12TH ST",
            "city": "MOUNT VERNON",
            "state": "IL",
            "postal_code": "628644314",
            "telephone_number": "618-244-4850",
            "fax_number": "618-244-7985"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN ILLINOIS CONSULTANTS FOR KIDNEY DISEASE, S.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-10",
        "last_updated": "2012-01-27",
        "status": "A",
        "authorized_official_last_name": "ZELMAN",
        "authorized_official_first_name": "STEVEN",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "C.E.O.",
        "authorized_official_telephone_number": "618-244-4850",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "IL",
            "license": "060-007470",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3523854003",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "4123105",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mount Vernon, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2012; 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.