NPIMap

Organization Active NPI

Decatur Orthopedic Center, LLC

  • Orthopaedic Surgery Physician
  • Mt Zion, IL
National Provider Identifier
1336586114
Registry record updated Feb 23, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
License
125-052745 Issued in IL
Legal business name
DECATUR ORTHOPEDIC CENTER, LLC
Practice address
104 Ashland Ave.
Mt. Zion, IL 62549
Phone
(217) 864-2665
NPI assigned
Jun 3, 2013
Last updated
Feb 23, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 23, 2022

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

Authorized official

Name
Dr. Jacob D Sams, MDNPI 1730340498
Title
Chief Managing Member
Phone
(217) 864-2665

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery Physician 207X00000X 125-052745 IL Primary

Addresses

Primary practice location

104 Ashland Ave.
Mt. Zion, IL 62549

Mailing address

104 Ashland Ave.
Mt. Zion, IL 62549
Phone (217) 864-2665

Other identifiers 2

IdentifierTypeStateIssuer
1154511517OtherILINDIVIDUAL NPI
1730340498OtherILINDIVIDUAL NPI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20130710000446 IL Part B Supplier - Clinic/Group Practice 4981844289 Receives reassigned benefits from 17 practitioners
Practice locations: Mt Zion, IL
O20140317000642 IL DME Supplier - Physician - Orthopedic/Orthopedic Surgery 4981844289 Practice locations: Mt Zion, IL

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 19

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1370217600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1645574400000",
    "number": "1336586114",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "104 ASHLAND AVE.",
            "city": "MT. ZION",
            "state": "IL",
            "postal_code": "62549",
            "telephone_number": "217-864-2665"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 ASHLAND AVE.",
            "city": "MT. ZION",
            "state": "IL",
            "postal_code": "62549",
            "telephone_number": "217-864-2665"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DECATUR ORTHOPEDIC CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-06-03",
        "last_updated": "2022-02-23",
        "certification_date": "2022-02-23",
        "status": "A",
        "authorized_official_last_name": "SAMS",
        "authorized_official_first_name": "JACOB",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "CHIEF MANAGING MEMBER",
        "authorized_official_telephone_number": "217-864-2665",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "IL",
            "license": "125-052745",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL NPI",
            "identifier": "1154511517",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL NPI",
            "identifier": "1730340498",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mt Zion, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.