Individual provider Active NPI

Kevin L Rainey, PAC

  • Physician Assistant
  • Herrin, IL
National Provider Identifier
1215042833
Registry record updated Oct 7, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
085002094 Issued in IL
Practice address
510 Lincoln Drive
Southern Orthopedic Associates SC
Herrin, IL 62948
Phone
(618) 997-6800
Fax
(618) 998-9124
NPI assigned
Aug 21, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 7, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 085002094 IL Primary

Addresses

Primary practice location

510 Lincoln Drive
Southern Orthopedic Associates SC
Herrin, IL 62948

Mailing address

510 Lincoln Drive
Southern Orthopedic Associates SC
Herrin, IL 62948
Phone (618) 997-6800

Other practice location 1

901 S Commercial St
Harrisburg, IL 62946-2640
Phone (618) 993-3817

Other practice location 2

2808 East Outer Drive
Marion, IL 62959-6295
Phone (618) 993-3817

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address krainey62626@sih.direct-ci.com
Direct Messaging Address krainey62626@sih.direct-ci.com

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040510001338 IL Practitioner - Physician Assistant 5890784326 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Southern Illinois Medical Services NFPGroup PAC ID 3678677390, 331 clinicians

Practice addresses (Care Compare)

2601 W Main St
Carbondale, IL 62901-1031
Phone (618) 549-5361

2808 E Outer Dr
Marion, IL 62959-5207
Phone (618) 993-3817

Merit-based Incentive Payment System (MIPS)

Final score
82 of 100Reported as group
Quality
55.9
Promoting interoperability
100
Improvement activities
40
Cost
72.01

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
085002094ILMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Southern Illinois Medical Services, NFP CurrentSince Oct 1, 2022 Accepting new patients
Craig W. Furry Past Accepting new patients

Locations

2601 W Main St
Carbondale, IL 62901
Phone (618) 351-7300

901 S Commercial St
Harrisburg, IL 62946
Phone (618) 252-0411

510 Lincoln Dr
Herrin, IL 62948
Phone (618) 997-3100

2808 Outer Dr
Marion, IL 62959
Phone (618) 993-3817

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1156118400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1665100800000",
    "number": "1215042833",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "510 LINCOLN DRIVE",
            "address_2": "SOUTHERN ORTHOPEDIC ASSOCIATES SC",
            "city": "HERRIN",
            "state": "IL",
            "postal_code": "62948",
            "telephone_number": "618-997-6800",
            "fax_number": "618-998-9124"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "510 LINCOLN DRIVE",
            "address_2": "SOUTHERN ORTHOPEDIC ASSOCIATES SC",
            "city": "HERRIN",
            "state": "IL",
            "postal_code": "62948",
            "telephone_number": "618-997-6800",
            "fax_number": "618-998-9124"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "901 S Commercial St",
            "address_purpose": "LOCATION",
            "city": "Harrisburg",
            "state": "IL",
            "postal_code": "629462640",
            "country_code": "US",
            "telephone_number": "618-993-3817",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2808 East Outer Drive",
            "address_purpose": "LOCATION",
            "city": "Marion",
            "state": "IL",
            "postal_code": "629596295",
            "country_code": "US",
            "telephone_number": "618-993-3817",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RAINEY",
        "first_name": "KEVIN",
        "middle_name": "L",
        "name_prefix": "Mr.",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-21",
        "last_updated": "2022-10-07",
        "certification_date": "2022-10-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085002094",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "krainey62626@sih.direct-ci.com",
            "affiliation": "N",
            "address_1": "901 S Commercial St",
            "city": "Harrisburg",
            "state": "IL",
            "country_code": "US",
            "postal_code": "629462640",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "krainey62626@sih.direct-ci.com",
            "affiliation": "N",
            "address_1": "2808 East Outer Drive",
            "city": "Marion",
            "state": "IL",
            "country_code": "US",
            "postal_code": "629596295",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Herrin, IL

Sources for this page

Verify at the official NPI Registry.