Individual provider Active NPI

Mariah Gloria Teriet

  • Nurse Practitioner
  • Marion, IL
National Provider Identifier
1275267262
Registry record updated Sep 15, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
209025444 Issued in IL
Practice address
2808 East Outer Dr
Marion, IL 62959-5207
Phone
(618) 993-3817
NPI assigned
Jul 14, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 15, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 209025444 IL Primary

Addresses

Primary practice location

2808 East Outer Dr
Marion, IL 62959-5207

Mailing address

2808 East Outer Dr
Marion, IL 62959-5207
Phone (618) 993-3817

Other practice location 1

901 S Commercial St
Harrisburg, IL 62946-2640
Phone (618) 993-3817

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address mteriet51070@sih.direct-ci.com
Direct Messaging Address mteriet51070@sih.direct-ci.com

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20221018002156 IL Practitioner - Nurse Practitioner 5294101101 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Southern Illinois Medical Services NFPGroup PAC ID 3678677390, 331 clinicians
Physician Services Corporation of Southern Illinois IncGroup PAC ID 9234022567, 120 clinicians

Practice addresses (Care Compare)

2808 E Outer Dr
Marion, IL 62959-5207
Phone (618) 993-3817

602 S 42ND St
B
Mount Vernon, IL 62864-6264
Phone (618) 899-3278

Merit-based Incentive Payment System (MIPS)

Final score
82 of 100Reported as group
Quality
55.9
Promoting interoperability
100
Improvement activities
40
Cost
72.01

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
209025444ILMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Southern Illinois Medical Services, NFP CurrentSince Sep 15, 2022 Accepting new patients

Locations

2601 W Main St
Carbondale, IL 62901
Phone (618) 351-7300

901 S Commercial St
Harrisburg, IL 62946
Phone (618) 252-0411

2808 Outer Dr
Marion, IL 62959
Phone (618) 993-3817

Interoperability endpoints

  • Direct secure messaging: mteriet51070@sih.direct-ci.com

Organizations & group practices 2

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.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1657756800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1663200000000",
    "number": "1275267262",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2808 EAST OUTER DR",
            "city": "MARION",
            "state": "IL",
            "postal_code": "629595207",
            "telephone_number": "618-993-3817"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2808 EAST OUTER DR",
            "city": "MARION",
            "state": "IL",
            "postal_code": "629595207",
            "telephone_number": "618-993-3817"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "901 S Commercial St",
            "address_purpose": "LOCATION",
            "city": "Harrisburg",
            "state": "IL",
            "postal_code": "629462640",
            "country_code": "US",
            "telephone_number": "618-993-3817",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TERIET",
        "first_name": "MARIAH",
        "middle_name": "GLORIA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-07-14",
        "last_updated": "2022-09-15",
        "certification_date": "2022-09-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IL",
            "license": "209025444",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mteriet51070@sih.direct-ci.com",
            "affiliation": "N",
            "address_1": "901 S Commercial St",
            "city": "Harrisburg",
            "state": "IL",
            "country_code": "US",
            "postal_code": "629462640",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mteriet51070@sih.direct-ci.com",
            "affiliation": "N",
            "address_1": "2808 East Outer Dr",
            "city": "Marion",
            "state": "IL",
            "country_code": "US",
            "postal_code": "629595207",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Marion, IL

Sources for this page

Verify at the official NPI Registry.