Active NPI
Alexandra Marie Ishmael, LICENSED DIETITIAN
- Registered Dietitian
- Springfield, IL
National Provider Identifier
1265099758
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- Practice address
- 319 E Madison St Ste 1F
Springfield, IL 62701-1035 - Phone
- (217) 788-3948
- Fax
- (217) 527-3209
- NPI assigned
- May 21, 2019
- 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 |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | Primary |
Addresses
Primary practice location
319 E Madison St Ste 1F
Springfield, IL 62701-1035
Mailing address
PO Box 3428
Springfield, IL 62708-3428
Phone (800) 577-5368
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 164007543 | Other | IL | LICENSED DIETITIAN NUTRITIONIST LICENSE |
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)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1558396800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1558396800000",
"number": "1265099758",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 3428",
"city": "SPRINGFIELD",
"state": "IL",
"postal_code": "627083428",
"telephone_number": "800-577-5368",
"fax_number": "217-757-2021"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "319 E MADISON ST STE 1F",
"city": "SPRINGFIELD",
"state": "IL",
"postal_code": "627011035",
"telephone_number": "217-788-3948",
"fax_number": "217-527-3209"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ISHMAEL",
"first_name": "ALEXANDRA",
"middle_name": "MARIE",
"credential": "LICENSED DIETITIAN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-05-21",
"last_updated": "2019-05-21",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSED DIETITIAN NUTRITIONIST LICENSE",
"identifier": "164007543",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Springfield, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.