NPIMap

Individual provider Active NPI

Liudmila Vasilets, MD

  • Internal Medicine Physician
  • Marion, IL
National Provider Identifier
1225525579
Registry record updated Sep 9, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
036.155616 Issued in IL
Practice address
3111 Williamson County Pkwy
Marion, IL 62959-5235
Phone
(618) 519-9200
Fax
(618) 985-9155
NPI assigned
Apr 21, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 9, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Internal Medicine Physician 207R00000X 036.155616 IL Primary

Addresses

Primary practice location

3111 Williamson County Pkwy
Marion, IL 62959-5235

Mailing address

109 California St.
PO Box 577
Carterville, IL 62918-0577
Phone (618) 519-9200

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
I20210922001118 IL Practitioner - Internal Medicine 7911304761 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Select Physical Therapy Holdings IncGroup PAC ID 9537076401, shared by 76 NPIs, 1,992 clinicians

Practice addresses (Care Compare)

1006 S Division St
Carterville, IL 62918-1539
Phone (618) 985-4841

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

2 S Hospital Dr
Murphysboro, IL 62966-3333
Phone (618) 942-2171

7 S Hospital Dr
Murphysboro, IL 62966-3333
Phone (618) 687-3418

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036.155616ILMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Shawnee Health Service and Development Corp CurrentSince Sep 20, 2021 Accepting new patients
Shawnee Health Service and Development Corp CurrentSince Sep 20, 2021 Accepting new patients
Shawnee Health Service and Development Corp Current Accepting new patients
Shawnee Health Service and Development Corp Past Accepting new patients

Locations

109 California St
Carterville, IL 62918
Phone (618) 985-8221

1006 S Division St
Carterville, IL 62918
Phone (618) 985-4841

3111 Williamson County Pkwy
Marion, IL 62959
Phone (618) 997-3647

Interoperability endpoints

  • Direct secure messaging: liudmila.vasilets.1@14668.direct.athenahealth.com

Organizations & group practices 4

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 6

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": "1524268800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1631145600000",
    "number": "1225525579",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "109 CALIFORNIA ST.",
            "address_2": "PO BOX 577",
            "city": "CARTERVILLE",
            "state": "IL",
            "postal_code": "629180577",
            "telephone_number": "618-519-9200",
            "fax_number": "618-985-4635"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3111 WILLIAMSON COUNTY PKWY",
            "city": "MARION",
            "state": "IL",
            "postal_code": "629595235",
            "telephone_number": "618-519-9200",
            "fax_number": "618-985-9155"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VASILETS",
        "first_name": "LIUDMILA",
        "name_prefix": "Mrs.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-04-21",
        "last_updated": "2021-09-09",
        "certification_date": "2021-09-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036.155616",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Marion, IL

Sources for this page

Verify at the official NPI Registry.