NPIMap

Individual provider Active NPI

Rajendra R Shroff, M.D.

  • Internal Medicine Physician
  • Centralia, IL
National Provider Identifier
1245259274
Registry record updated Nov 14, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
036065196 Issued in IL
Practice address
1050 M L King Dr
Suite 101
Centralia, IL 62801-3060
Phone
(618) 532-5700
Fax
(618) 532-7390
NPI assigned
Jul 19, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 14, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 036065196 IL Primary

Addresses

Primary practice location

1050 M L King Dr
Suite 101
Centralia, IL 62801-3060

Mailing address

1050 M L King Dr
Suite 101
Centralia, IL 62801-3060
Phone (618) 532-5700

Other identifiers 3

IdentifierTypeStateIssuer
0006100111OtherILBLUE CROSS
110230961OtherILPALMETTO MEDICARE
036065196MedicaidIL

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
I20050427000691 IL Practitioner - Internal Medicine 6103865381 Reassigns benefits to 2 organizations
Practice locations: Centralia, IL; Odin, IL; Salem, IL

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1978
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St Marys Hospital Centralia IllinoisGroup PAC ID 6709788920, 118 clinicians

Practice addresses (Care Compare)

1050 M L King Dr
Centralia, IL 62801-3060
Phone (618) 532-5700

2049 E McCord St
Centralia, IL 62801-6784
Phone (618) 532-4590

400 N Pleasant Ave
Centralia, IL 62801-3056
Phone (618) 436-8000

Hospital & facility affiliations

  • SSM Health at Home Health-Illinois Home health agency, Mount Vernon, IL, CCN 147088
  • Mederi Caretenders Home health agency, Mount Vernon, IL, CCN 147251
  • Residential Home Health of Southern Illinois Home health agency, Glen Carbon, IL, CCN 147039
  • Mederi Caretenders of Fairview Heights Home health agency, Fairview Heights, IL, CCN 147289
  • SSM Health St Mary'S Hospital -Centralia Hospital, Centralia, IL, CCN 140034
  • Good Samaritan Regional HLTH Center Hospital, Mount Vernon, IL, CCN 140046
  • Salem Township Hospital Hospital, Salem, IL, CCN 141345
  • Fayette County Hospital Hospital, Vandalia, IL, CCN 141346
  • Barnes Jewish Hospital Hospital, Saint Louis, MO, CCN 260032
  • Odin Health and Rehab Center Nursing home, Odin, IL, CCN 145649
  • Fireside House of Centralia Nursing home, Centralia, IL, CCN 145791
  • Centralia Manor Nursing home, Centralia, IL, CCN 145666

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Physician Services Corporation of Southern Illinois Inc. Internal Medicine CurrentSince May 15, 2009 Accepting new patients
St. Mary'S Hospital, Centralia, Illinois CurrentSince Dec 8, 1997 Accepting new patients
St. Mary'S Hospital, Centralia, Illinois CurrentSince Dec 8, 1997 Accepting new patients
Rajendra R Shroff MD SC Internal Medicine PastSince Jan 1, 1966 Accepting new patients
Rajendra R Shroff MD SC Internal Medicine PastSince Jan 1, 1966 Accepting new patients

Locations

1050 Martin Luther King Dr
Ste 101
Centralia, IL 62801
Phone (618) 532-0100

400 N Pleasant Ave
Centralia, IL 62801
Phone (618) 436-5221

7420 Solutions Ctr
Chicago, IL 60677
Phone (314) 989-3155

2 Good Samaritan Way
Ste 320
Mount Vernon, IL 62864
Phone (618) 899-1944

1145 Corporate Lake Dr
Saint Louis, MO 63132
Phone (314) 989-6189

Interoperability endpoints

  • Direct secure messaging: rshroff82055@direct-ehr-ssmhc.com

Ownership & related parties

All facility ownership & control disclosures 5

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

FacilityTypeRoleSince
SSM Health Good Samaritan Hospital - Mt. VernonMount Vernon, IL, CCN 140046 Hospital Corporate Director Mar 16, 2023
SSM Health St. Mary'S Hospital-CentraliaCentralia, IL, CCN 14S034 Hospital Corporate Director Mar 16, 2023
SSM Health St. Mary'S Hospital - CentraliaCentralia, IL, CCN 140034 Hospital Corporate Director Mar 16, 2023
SSM Health Good Samaritan Hospital - Mt VernonMount Vernon, IL, CCN 14T046 Hospital Corporate Director Mar 16, 2023
Odin Health and Rehab CenterOdin, IL, CCN 145649 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 May 1, 2024
May 1, 2024

Owned or controlled facilities with NPI records 5

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

Organizations & group practices 7

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 12

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": "1153267200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1321228800000",
    "number": "1245259274",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1050 M L KING DR",
            "address_2": "SUITE 101",
            "city": "CENTRALIA",
            "state": "IL",
            "postal_code": "628013060",
            "telephone_number": "618-532-5700",
            "fax_number": "618-532-7390"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1050 M L KING DR",
            "address_2": "SUITE 101",
            "city": "CENTRALIA",
            "state": "IL",
            "postal_code": "628013060",
            "telephone_number": "618-532-5700",
            "fax_number": "618-532-7390"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHROFF",
        "first_name": "RAJENDRA",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-19",
        "last_updated": "2011-11-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036065196",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "0006100111",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PALMETTO MEDICARE",
            "identifier": "110230961",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036065196",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Centralia, IL

Sources for this page

Verify at the official NPI Registry.