NPIMap

Individual provider Active NPI

Poojitha Kolluri, MD

  • Family Medicine Physician
  • Shelbyville, IL
National Provider Identifier
1306402870
Registry record updated May 13, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
036158456 Issued in IL
Practice address
200 S Cedar St
Shelbyville, IL 62565-1838
Phone
(217) 774-4400
Fax
(217) 774-6445
NPI assigned
May 10, 2019
Reactivated
Feb 8, 2020
Last updated
May 13, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 13, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Family Medicine Physician 207Q00000X 036158456 IL Primary

Addresses

Primary practice location

200 S Cedar St
Shelbyville, IL 62565-1838

Mailing address

2200 Jefferson Avenue - Mercy Family Physician
Toledo, OH 43604
Phone (419) 251-1859

Other practice location 1

2200 Jefferson Avenue - Mercy Family Physician
Toledo, OH 43604
Phone (419) 251-1859

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
I20220525002763 IL Practitioner - Family Practice 7214333442 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
HSHS Medical Group IncGroup PAC ID 5092857821, 212 clinicians

Practice addresses (Care Compare)

200 S Cedar St
Shelbyville, IL 62565-1838
Phone (217) 774-3961

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
HSHS Medical Group Inc CurrentSince Sep 15, 2022 Accepting new patients
HSHS Good Shepherd Hospital Inc CurrentSince Jul 11, 2022 Accepting new patients
HSHS Good Shepherd Hospital Inc CurrentSince Jul 11, 2022 Accepting new patients
HSHS Medical Group Inc CurrentSince Sep 15, 2022 Accepting new patients

Locations

1900 E Lake Shore Dr
Ste 330
Decatur, IL 62521
Phone (217) 423-2889

1512 N Green Mount Rd
O Fallon, IL 62269
Phone (618) 624-0100

200 S Cedar St
Shelbyville, IL 62565
Phone (217) 774-3961

3051 Hollis Dr
Fl 2
Springfield, IL 62704
Phone (217) 321-9321

1304 Burnett Dr
Taylorville, IL 62568
Phone (217) 321-9310

Interoperability endpoints

  • Direct secure messaging: pkolluri355068@ewd.direct.hshs.org

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 10

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": "1557446400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1652400000000",
    "number": "1306402870",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2200 JEFFERSON AVENUE - MERCY FAMILY PHYSICIAN",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "43604",
            "telephone_number": "419-251-1859",
            "fax_number": "419-251-4159"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 S CEDAR ST",
            "city": "SHELBYVILLE",
            "state": "IL",
            "postal_code": "625651838",
            "telephone_number": "217-774-4400",
            "fax_number": "217-774-6445"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2200 Jefferson Avenue - Mercy Family Physician",
            "address_purpose": "LOCATION",
            "city": "Toledo",
            "state": "OH",
            "postal_code": "43604",
            "country_code": "US",
            "telephone_number": "419-251-1859",
            "fax_number": "419-251-4159",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KOLLURI",
        "first_name": "POOJITHA",
        "name_prefix": "Ms.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-05-10",
        "last_updated": "2022-05-13",
        "certification_date": "2022-05-13",
        "deactivation_date": "2020-01-13",
        "reactivation_date": "2020-02-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036158456",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Shelbyville, IL

Sources for this page

Verify at the official NPI Registry.