Prairie Podiatry L.L.C.

Primary specialty

PodiatristTaxonomy code 213E00000X

License

016004443 Issued in IL

Legal business name

PRAIRIE PODIATRY L.L.C.

Practice address

2070 W Iles Ave
Springfield, IL 62704-4174

Phone

(217) 698-6228

Fax

(217) 698-7241

NPI assigned

Mar 28, 2007

Last updated

Feb 22, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. John Andrew Shoudel, DPMNPI 1760480750

Title

Owner

Phone

(217) 698-6228

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Locations

Practitioners 4

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.

• Joseph P. Rolens, DPM

  • Podiatrist
  • Springfield, IL
  • NPI 1710329271
  Medicare reassignment Care Compare group NPD
• Richard Lee Brown, D.P.M.

  • Foot & Ankle Surgery Podiatrist
  • Springfield, IL
  • NPI 1275531188
  Medicare reassignment Care Compare group
• Thomas John Cockayne Jr., DPM

  • Podiatrist
  • Chicago, IL
  • NPI 1063820231
  Medicare reassignment Care Compare group
• John Andrew Shoudel, DPM

  • Foot & Ankle Surgery Podiatrist
  • Springfield, IL
  • NPI 1760480750
  Authorized official Same address or phone

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

{
    "created_epoch": "1175040000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1645488000000",
    "number": "1144349747",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2070 W ILES AVE",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627044174",
            "telephone_number": "217-698-6228",
            "fax_number": "217-698-7241"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2070 W ILES AVE",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627044174",
            "telephone_number": "217-698-6228",
            "fax_number": "217-698-7241"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRAIRIE PODIATRY L.L.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-28",
        "last_updated": "2022-02-22",
        "certification_date": "2022-02-22",
        "status": "A",
        "authorized_official_last_name": "SHOUDEL",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "ANDREW",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "217-698-6228",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "IL",
            "license": "016004443",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "60101308",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Prairie Cardiovascular Consultants LTD
• Prairie Cardiovascular Consultants LTD
• Prairie Diagnostic Center, LLC
• Prairie Eye Center LTD (Prairie Retina Center)
• Prairie Eye Center, LTD (Prairie Eye & Lasik Center)
• Prairie Psychotherapy Associates, PC
• Prairie Sleep Center LLC
• Prairie Sleep Center LLC
• Vidhya Prakash, M.D.
• Pinnamaneni Prasad, MD

• Podiatrist in Springfield, IL
• Providers in Springfield, IL by specialty
• Podiatrist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2022; 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.