NPIMap

Individual provider Active NPI

Ralph I Latta, MD

  • Family Medicine Physician
  • Benton, IL
National Provider Identifier
1215956602
Registry record updated Nov 11, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
036114358 Issued in IL
Practice address
501 N Duquoin
Benton, IL 62812-5228
Phone
(618) 435-5362
Fax
(618) 438-2613
NPI assigned
Jul 18, 2006
Last updated
Nov 11, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 11, 2020

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 036114358 IL Primary

Addresses

Primary practice location

501 N Duquoin
Benton, IL 62812-5228

Mailing address

PO Box 1228
501 N Duquoin
Benton, IL 62812-5228
Phone (618) 435-5362

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address rlatta76652@direct-ehr-ssmhc.com Direct
FHIR URL https://fhir.ssmhc.com/fhir/api/FHIR/DSTU2/ Other

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060428000045 IL Practitioner - Family PracticePractitioner - Emergency Medicine 4789694290 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Illinois College of Med (CHI/Peor/Rock/CHM-Urb), 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Select Physical Therapy Holdings IncGroup PAC ID 9537076401, shared by 76 NPIs, 1,992 clinicians
Physician Services Corporation of Southern Illinois IncGroup PAC ID 9234022567, 120 clinicians

Practice addresses (Care Compare)

1104 W Main St
Benton, IL 62812-1565
Phone (618) 439-3399

326 E Main St
West Frankfort, IL 62896-2402
Phone (618) 937-6200

501 N Du Quoin St
Benton, IL 62812-1224
Phone (618) 435-5362

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Yates Emergency Physicians Past Accepting new patients
Good Samaritan Regional Health Center Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: rlatta@yourcarecommunity.org
  • Direct secure messaging: rlatta76652@direct-ehr-ssmhc.com

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
SSM Health Medical GroupCentralia, IL, CCN 783803 Rural health clinic Corporate Director Jan 1, 2019

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 3

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

Hospital & facility affiliations 9

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": "1153180800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1605052800000",
    "number": "1215956602",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1228",
            "address_2": "501 N DUQUOIN",
            "city": "BENTON",
            "state": "IL",
            "postal_code": "628125228",
            "telephone_number": "618-435-5362",
            "fax_number": "618-438-2613"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 N DUQUOIN",
            "city": "BENTON",
            "state": "IL",
            "postal_code": "628125228",
            "telephone_number": "618-435-5362",
            "fax_number": "618-438-2613"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LATTA",
        "first_name": "RALPH",
        "middle_name": "I",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-18",
        "last_updated": "2020-11-11",
        "certification_date": "2020-11-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036114358",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "rlatta76652@direct-ehr-ssmhc.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "rlatta76652@direct-ehr-ssmhc.com",
            "address_1": "501 N DuQuoin",
            "city": "Benton",
            "state": "IL",
            "country_code": "US",
            "postal_code": "628125228",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://fhir.ssmhc.com/fhir/api/FHIR/DSTU2/",
            "affiliation": "N",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "FHIR API",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCD",
            "address_1": "501 N DuQuoin",
            "city": "Benton",
            "state": "IL",
            "country_code": "US",
            "postal_code": "628125228",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Benton, IL

Sources for this page

Verify at the official NPI Registry.