Individual provider Active NPI

Maria Riaz, MD

  • Internal Medicine Physician
  • Centralia, IL
National Provider Identifier
1245751940
Registry record updated Nov 17, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
036154172 Issued in IL
Practice address
1441 W Broadway
Centralia, IL 62801-5613
Phone
(618) 532-9050
NPI assigned
Jul 3, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 17, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 036154172 IL Primary
Student in an Organized Health Care Education/Training Program 390200000X

Addresses

Primary practice location

1441 W Broadway
Centralia, IL 62801-5613

Mailing address

1441 W Broadway
Centralia, IL 62801-5613
Phone (618) 532-9050

Other practice location 1

82-68 164th street, Jamaica
Queens Hospital Center,
new york, NY 11432
Phone (917) 640-8301

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address mriaz381245@direct-ehr-ssmhc.com Direct
FHIR URL https://fhir.ssmhc.com/fhir/api/FHIR/DSTU2/ Other

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20201005002063 IL Practitioner - Internal Medicine 5294074944 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Physician Services Corporation of Southern Illinois IncGroup PAC ID 9234022567, 120 clinicians

Practice addresses (Care Compare)

1441 W Broadway
Centralia, IL 62801-5613
Phone (618) 532-9050

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036154172ILMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Physician Services Corporation of Southern Illinois Inc. Internal Medicine CurrentSince Nov 1, 2020 Accepting new patients

Locations

811 Fairfax St
Carlyle, IL 62231
Phone (618) 594-3025

1441 W Broadway
Centralia, IL 62801
Phone (618) 532-0810

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

Interoperability endpoints

  • Direct secure messaging: mriaz381245@direct-ehr-ssmhc.com

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.

Hospital & facility affiliations 5

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": "1499040000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1605571200000",
    "number": "1245751940",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1441 W BROADWAY",
            "city": "CENTRALIA",
            "state": "IL",
            "postal_code": "628015613",
            "telephone_number": "618-532-9050"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1441 W BROADWAY",
            "city": "CENTRALIA",
            "state": "IL",
            "postal_code": "628015613",
            "telephone_number": "618-532-9050"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "82-68 164th street, Jamaica",
            "address_2": "Queens Hospital Center,",
            "address_purpose": "LOCATION",
            "city": "new york",
            "state": "NY",
            "postal_code": "11432",
            "country_code": "US",
            "telephone_number": "917-640-8301",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RIAZ",
        "first_name": "MARIA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-07-03",
        "last_updated": "2020-11-17",
        "certification_date": "2020-11-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036154172",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mriaz381245@direct-ehr-ssmhc.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "mriaz381245@direct-ehr-ssmhc.com",
            "address_1": "1441 W Broadway",
            "city": "Centralia",
            "state": "IL",
            "country_code": "US",
            "postal_code": "628015613",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://fhir.ssmhc.com/fhir/api/FHIR/DSTU2/",
            "affiliation": "N",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "FHIR API",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCD",
            "address_1": "1441 W Broadway",
            "city": "Centralia",
            "state": "IL",
            "country_code": "US",
            "postal_code": "628015613",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Centralia, IL

Sources for this page

Verify at the official NPI Registry.