NPIMap

Individual provider Active NPI

Alfonso E Urdaneta, MD

  • Family Medicine Physician
  • Nashville, IL
National Provider Identifier
1225085590
Registry record updated Nov 3, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
036047128 Issued in IL
Practice address
705 South Grand Avenue
Nashville, IL 62263-1534
Phone
(618) 327-2225
Fax
(618) 327-2229
NPI assigned
May 30, 2006
Last updated
Nov 3, 2009By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 3, 2009

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 036047128 IL
Family Medicine Physician 207Q00000X 036047128 IL Primary

Addresses

Primary practice location

705 South Grand Avenue
Nashville, IL 62263-1534

Mailing address

3416 Hotze Road
Salem, IL 62881-6616
Phone (618) 548-1185

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
I20100123000041 IL Practitioner - Family PracticePractitioner - General SurgeryPractitioner - Emergency Medicine 5597807909 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family PracticeAlso: Emergency Medicine, General Surgery
Education
Other, 1967
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

705 S Grand
Nashville, IL 62263-1534

705 S Grand St
Nashville, IL 62263-1534
Phone (618) 327-8236

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036047128ILMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Washington County Hospital District CurrentSince May 19, 2000 Accepting new patients
Washington County Hospital District CurrentSince May 19, 2000 Accepting new patients
Integritas Emergency Physician Services, LLC CurrentSince Aug 1, 2018 Accepting new patients
Washington County Hospital District Past Accepting new patients
Washington County Hospital District Past Accepting new patients

Locations

2250 N Illinois Ave
Carbondale, IL 62901
Phone (618) 833-1691

1245 S Mill St
Nashville, IL 62263
Phone (618) 327-8119

705 S Grand St
Nashville, IL 62263
Phone (618) 327-2200

Interoperability endpoints

  • Direct secure messaging: aurdaneta335442@direct-ehr-ssmhc.com

Organizations & group practices 5

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 7

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": "1148947200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1257206400000",
    "number": "1225085590",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3416 HOTZE ROAD",
            "city": "SALEM",
            "state": "IL",
            "postal_code": "628816616",
            "telephone_number": "618-548-1185"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "705 SOUTH GRAND AVENUE",
            "city": "NASHVILLE",
            "state": "IL",
            "postal_code": "622631534",
            "telephone_number": "618-327-2225",
            "fax_number": "618-327-2229"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "URDANETA",
        "first_name": "ALFONSO",
        "middle_name": "E",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-30",
        "last_updated": "2009-11-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "IL",
            "license": "036047128",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036047128",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Nashville, IL

Sources for this page

Verify at the official NPI Registry.