Mohammad Baraa Boozo
Individual provider Active NPI Internal Medicine Physician · Springfield, IL
NPI 1245127307 · NPPES record last updated Jun 21, 2025
Key facts
- NPI
- 1245127307
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Internal Medicine Physician 207R00000X
- License
- 125086379 (IL)
- Practice address
- 751 N Rutledge St RM 1100
Springfield, IL 62702-4968 - Phone
- (217) 545-8000
- Fax
- (217) 545-9730
- NPI assigned
- Jun 21, 2025
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250708002692 | IL | Order and Referring Only - Internal Medicine |
6901310457 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Board of Trustees of Southern Illinois University | Current | Accepting new patients |
Interoperability endpoints
- mohammadbaraaboozo@siusm.allscriptsdirect.net
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 125086379 | IL | Yes |
Addresses
Primary practice location
751 N Rutledge St RM 1100
Springfield, IL 62702-4968
Mailing address
PO Box 19636
Springfield, IL 62794-9636
Phone (217) 545-8000
Other providers in Springfield, IL
- Steven Kent Bone
- Pamela Kay Bonjean
- Leighanne Bonnett
- Leah R Boon
- Gregory Tyler Booth
- Mallory Bopp
- Alesa C Borders
- Simone Wall Borges-Young
- Julie Borjon
- Amanda J Bormann
All providers in Springfield, IL · Internal Medicine Physician in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 21, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.