Michael Sangwoo An, DPM
Individual provider Active NPI Foot & Ankle Surgery Podiatrist · Stony Brook, NY
NPI 1265060149 · NPPES record last updated Aug 7, 2024
Key facts
- NPI
- 1265060149
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Foot & Ankle Surgery Podiatrist 213ES0103X
- License
- 016006074 (IL)
- Practice address
- 101 Nicolls Rd
Stony Brook, NY 11794-0001 - Phone
- (631) 689-8333
- NPI assigned
- Mar 27, 2020
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 8
Hospital & facility affiliations 2
Medicare Care Compare profile
- Specialty
- Podiatry
- Education
- Temple University School of Medicine, 2020
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Southern Illinois Medical Services NFP
Practice addresses (Care Compare)
408 Lincoln Dr
Suite B
Herrin, IL 62948-3790
Phone (618) 993-0900
Hospital & facility affiliations
- Herrin Hospital
- Memorial Hospital of Carbondale
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Melanoma (skin cancer) excision | 1-10 |
| Removal of tissue | 116 |
| Removal of nail tissue | 263 |
| Removal or shaving of skin growth | 69 |
| Skin biopsy | 1-10 |
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: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240917001899 | IL | Practitioner - Podiatry | 6305387432 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Southern Illinois Medical Services, NFP | Current |
Accepting new patients |
Locations
2601 W Main St
Carbondale, IL 62901
Phone (618) 351-7300
408 Lincoln Dr
Ste B
Herrin, IL 62948
Phone (618) 351-4980
19 E Shawnee Dr
Ste 3
Murphysboro, IL 62966
Phone (618) 565-1000
Interoperability endpoints
- man77374@sih.direct-ci.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Podiatrist | 213E00000X | 016006074 | IL | |
| Foot & Ankle Surgery Podiatrist | 213ES0103X | 016006074 | IL | Yes |
Addresses
Primary practice location
101 Nicolls Rd
Stony Brook, NY 11794-0001
Mailing address
PO Box 3988
Carbondale, IL 62902-3988
Phone (618) 457-5200
Other practice location 1
19 E Shawnee Dr Ste 3
Murphysboro, IL 62966-7072
Phone (618) 565-1000
Other practice location 2
2448 Federal St Unit 1
Philadelphia, PA 19146-2432
Phone (615) 830-2427
Other practice location 3
408 Lincoln Dr Ste B
Herrin, IL 62948-3790
Phone (618) 993-0900
Other providers in Stony Brook, NY
- Colton Barry Amaral
- Clarisa Amarillas Gastelum
- Ariana Concetta Ambrosio
- Lauren Ametrano
- Chelsea Amo-Tweneboah
- Enid Libertad Anaya
- Brianna Maria Anderson
- Tyler Kenneth Anderson
- Wesam F Andraous
- Donna Andricopoulos
All providers in Stony Brook, NY · Foot & Ankle Surgery Podiatrist in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 7, 2024. 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).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.