Active NPI
Terry L Reside, CST, SA-C
- Surgical Assistant
- Normal, IL
National Provider Identifier
1235468729
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgical Assistant
- License
- 238000219
- Practice address
- 1604 Visa Dr
Normal, IL 61761-2195 - Phone
- (309) 846-4716
- Fax
- (309) 454-1107
- NPI assigned
- Dec 14, 2009
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgical Assistant | 246ZC0007X | 238000219 | IL | Primary |
Addresses
Primary practice location
1604 Visa Dr
Normal, IL 61761-2195
Mailing address
1604 Visa Dr
Normal, IL 61761-2195
Phone (309) 846-4716
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 238000219 | IL | MD | Surgical Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Your Extra Hands Surgical Services PLLC | Surgical Assistant | Past | Accepting new patients |
Organizations & group practices 1
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.
-
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- Vero Beach, FL
- NPI 1114373040
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1260748800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1260748800000",
"number": "1235468729",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1604 VISA DR",
"city": "NORMAL",
"state": "IL",
"postal_code": "617612195",
"telephone_number": "309-846-4716",
"fax_number": "309-454-1107"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1604 VISA DR",
"city": "NORMAL",
"state": "IL",
"postal_code": "617612195",
"telephone_number": "309-846-4716",
"fax_number": "309-454-1107"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RESIDE",
"first_name": "TERRY",
"middle_name": "L",
"credential": "CST, SA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-12-14",
"last_updated": "2009-12-14",
"status": "A"
},
"taxonomies": [
{
"code": "246ZC0007X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Other, Surgical Assistant",
"state": "IL",
"license": "238000219",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Normal, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.