Individual provider Active NPI

Gary M Rull, M.D.

  • Internal Medicine Physician
  • Springfield, IL
National Provider Identifier
1154306017
Registry record updated Jun 22, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
036-103169 Issued in IL
Practice address
751 N Rutledge St
Ste 1100
Springfield, IL 62702-4909
Phone
(217) 545-0182
Fax
(217) 545-4735
NPI assigned
Dec 13, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 22, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 036-103169 IL Primary

Addresses

Primary practice location

751 N Rutledge St
Ste 1100
Springfield, IL 62702-4909

Mailing address

PO Box 19636
Springfield, IL 62794-9636
Phone (217) 545-0182

Other identifiers 1

IdentifierTypeStateIssuer
036103169MedicaidIL

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
I20100118000185 IL Practitioner - Internal Medicine 5698817468 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Southern Illinois University School of Medicine, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Board of Trustees of Southern Illinois UniversityGroup PAC ID 4486667888, 139 clinicians

Practice addresses (Care Compare)

751 N Rutledge St
Suite 1100
Springfield, IL 62702-4968
Phone (217) 545-8000

Hospital & facility affiliations

  • Memorial Medical Center Hospital, Springfield, IL, CCN 140148
  • St Johns Hospital Hospital, Springfield, IL, CCN 140053
  • Jacksonville Memorial Hospital Hospital, Jacksonville, IL, CCN 141352

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Board of Trustees of Southern Illinois University CurrentSince Jun 5, 2021 Accepting new patients
Board of Trustees of Southern Illinois University CurrentSince Jun 5, 2021 Accepting new patients
Siu Physicians & Surgeons, Inc Internal Medicine CurrentSince May 30, 2001 Accepting new patients
Board of Trustees of Southern Illinois University Current Accepting new patients
Siu Physicians & Surgeons, Inc CurrentSince May 30, 2001 Accepting new patients
Southern Illinois University Past Accepting new patients

Locations

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

751 N Rutledge St
Ste 1100
Springfield, IL 62702
Phone (217) 545-0182

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

201 E Madison St
Ste 328
Springfield, IL 62702

Interoperability endpoints

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

Organizations & group practices 6

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

Hospital & facility affiliations 3

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": "1134432000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1245628800000",
    "number": "1154306017",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 19636",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627949636",
            "telephone_number": "217-545-0182",
            "fax_number": "217-545-4735"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "751 N RUTLEDGE ST",
            "address_2": "STE 1100",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627024909",
            "telephone_number": "217-545-0182",
            "fax_number": "217-545-4735"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RULL",
        "first_name": "GARY",
        "middle_name": "M",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-13",
        "last_updated": "2009-06-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036-103169",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036103169",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Springfield, IL

Sources for this page

Verify at the official NPI Registry.