Individual provider Active NPI

Kyaw T Naing, M.D., PH.D.

  • Family Medicine Physician
  • Carbondale, IL
National Provider Identifier
1215913181
Registry record updated May 19, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
036-091952 Issued in IL
Practice address
305 W Jackson St
Ste 200
Carbondale, IL 62901-1474
Phone
(618) 536-6621
Fax
(618) 453-1102
NPI assigned
Dec 21, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 19, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 036-091952 IL Primary

Addresses

Primary practice location

305 W Jackson St
Ste 200
Carbondale, IL 62901-1474

Mailing address

305 W Jackson St
Ste 200
Carbondale, IL 62901-1474
Phone (618) 536-6621

Other practice location 1

2553 Ken Gray Blvd
West Frankfort, IL 62896-4174
Phone (618) 932-3937

Other identifiers 1

IdentifierTypeStateIssuer
036091952MedicaidIL

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address kyawnaing@siusm.allscriptsdirect.net
Direct Messaging Address knaing15459@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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100714000806 IL Practitioner - Family Practice 4183756919 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1978
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

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036-091952ILMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Siu Physicians & Surgeons, Inc Family Medicine CurrentSince Nov 1, 1997 Accepting new patients
Board of Trustees of Southern Illinois University CurrentSince Oct 28, 2020 Accepting new patients
Southern Illinois Hospital Services Current Accepting new patients
Siu Physicians & Surgeons, Inc CurrentSince Nov 1, 1997 Accepting new patients
Southern Illinois Hospital Services Family Medicine CurrentSince Jan 15, 2018 Accepting new patients
Board of Trustees of Southern Illinois University Family Medicine Current Accepting new patients
Southern Illinois Hospital Services CurrentSince Jan 15, 2018 Accepting new patients
Board of Trustees of Southern Illinois University Current Accepting new patients
Board of Trustees of Southern Illinois University CurrentSince Oct 28, 2020 Accepting new patients
Southern Illinois University Past Accepting new patients

Locations

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

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

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

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

Organizations & group practices 10

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 1

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": "1135123200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1652918400000",
    "number": "1215913181",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "305 W JACKSON ST",
            "address_2": "STE 200",
            "city": "CARBONDALE",
            "state": "IL",
            "postal_code": "629011474",
            "telephone_number": "618-536-6621",
            "fax_number": "618-453-1102"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "305 W JACKSON ST",
            "address_2": "STE 200",
            "city": "CARBONDALE",
            "state": "IL",
            "postal_code": "629011474",
            "telephone_number": "618-536-6621",
            "fax_number": "618-453-1102"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2553 Ken Gray Blvd",
            "address_purpose": "LOCATION",
            "city": "West Frankfort",
            "state": "IL",
            "postal_code": "628964174",
            "country_code": "US",
            "telephone_number": "618-932-3937",
            "fax_number": "618-932-2734",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NAING",
        "first_name": "KYAW",
        "middle_name": "T",
        "credential": "M.D., PH.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-21",
        "last_updated": "2022-05-19",
        "certification_date": "2020-12-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036-091952",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036091952",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kyawnaing@siusm.allscriptsdirect.net",
            "affiliation": "N",
            "address_1": "305 W Jackson St",
            "address_2": "STE 200",
            "city": "Carbondale",
            "state": "IL",
            "country_code": "US",
            "postal_code": "629011474",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "knaing15459@sih.direct-ci.com",
            "affiliation": "N",
            "address_1": "2553 Ken Gray Blvd",
            "city": "West Frankfort",
            "state": "IL",
            "country_code": "US",
            "postal_code": "628964174",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Carbondale, IL

Sources for this page

Verify at the official NPI Registry.