NPIMap

Individual provider Active NPI

Cheryl L Emmons, MD

  • Nephrology Physician
  • Mount Vernon, IL
National Provider Identifier
1295755114
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
036101232 Issued in IL
Practice address
1100 S 42ND St
Suite B
Mount Vernon, IL 62864-6216
Phone
(618) 244-5053
Fax
(618) 244-1355
NPI assigned
Jul 21, 2006
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X 036101232 IL Primary

Addresses

Primary practice location

1100 S 42ND St
Suite B
Mount Vernon, IL 62864-6216

Mailing address

1100 S 42ND St
Suite B
Mount Vernon, IL 62864-6216
Phone (618) 244-5053

Other identifiers 1

IdentifierTypeStateIssuer
4132016OtherILBCBS OF IL

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
I20040102000706 IL Practitioner - Internal MedicinePractitioner - Nephrology 2466351002 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Nephrology
Education
Other, 1983
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Select Physical Therapy Holdings IncGroup PAC ID 9537076401, shared by 76 NPIs, 1,992 clinicians

Practice addresses (Care Compare)

1100 S 42ND St
Suite B
Mount Vernon, IL 62864-6547
Phone (618) 244-5053

1104 W Main St
Benton, IL 62812-1565
Phone (618) 439-3399

4102 N Water Tower PL
Mount Vernon, IL 62864-6583
Phone (618) 244-3407

4225 Lincolnshire Dr
Suite B
Mount Vernon, IL 62864-2157

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as group

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Cheryl Emmons MDSC Nephrology CurrentSince Sep 11, 2002 Accepting new patients
Southern Illinois Consultants for Kidney Disease, S.C. Past Accepting new patients
University Internal Medicine Associates, Inc. Nephrology Past Accepting new patients
Crossroads Physician Corporation Past Accepting new patients

Locations

1100 S 42nd St
Ste B
Mount Vernon, IL 62864
Phone (618) 244-5053

4225 Lincolnshire Dr
Ste B
Mount Vernon, IL 62864

605 N 12th St
Mount Vernon, IL 62864
Phone (618) 241-1108

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 7

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": "1153440000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1295755114",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1100 S 42ND ST",
            "address_2": "SUITE B",
            "city": "MOUNT VERNON",
            "state": "IL",
            "postal_code": "628646216",
            "telephone_number": "618-244-5053",
            "fax_number": "618-244-1355"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 S 42ND ST",
            "address_2": "SUITE B",
            "city": "MOUNT VERNON",
            "state": "IL",
            "postal_code": "628646216",
            "telephone_number": "618-244-5053",
            "fax_number": "618-244-1355"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EMMONS",
        "first_name": "CHERYL",
        "middle_name": "L",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-21",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "IL",
            "license": "036101232",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF IL",
            "identifier": "4132016",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mount Vernon, IL

Sources for this page

Verify at the official NPI Registry.