Individual provider Active NPI

Donnie Edwin Shelton Jr., M.D.

  • Emergency Medicine Physician
  • Herrin, IL
National Provider Identifier
1346301025
Registry record updated Sep 28, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
036121910 Issued in IL
Practice address
201 S 14TH St
Herrin, IL 62948
Phone
(618) 942-2171
Fax
(618) 351-4917
NPI assigned
Dec 13, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 28, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 1250520017 IL
Emergency Medicine Physician 207P00000X 036121910 IL Primary

Addresses

Primary practice location

201 S 14TH St
Herrin, IL 62948

Mailing address

PO Box 3988
Carbondale, IL 62902-3988
Phone (618) 457-5200

Other practice location 1

2 S Hospital Dr
Murphysboro, IL 62966-3333
Phone (618) 684-3156

Other practice location 2

305 W Jackson St
Suite 200
Carbondale, IL 62901-1474
Phone (618) 549-0721

Other practice location 3

305 W Jackson St
Suite 200
Carbondale, IL 62901-1474
Phone (618) 549-0721

Electronic endpoints 3

TypeEndpointUseAffiliation
Direct Messaging Address dshelton14242@sih.direct-ci.com
Direct Messaging Address dshelton14242@sih.direct-ci.com
Direct Messaging Address dshelton14242@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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090130000504 IL Practitioner - Emergency MedicinePractitioner - Family Practice 2668536913 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Deaconess Illinois Specialty Clinic, Inc.Group PAC ID 9830562016, 145 clinicians

Practice addresses (Care Compare)

3333 W Deyoung St
Marion, IL 62959-5884
Phone (618) 998-7000

Hospital & facility affiliations

  • Heartland Regional Medical Center Hospital, Marion, IL, CCN 140184

Merit-based Incentive Payment System (MIPS)

Final score
77.51 of 100Reported as group
Quality
49.04
Promoting interoperability
95
Improvement activities
40
Cost
69.42

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036121910ILMDEmergency Medicine Physician
1250520017ILMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Deaconess Illinois Specialty Clinic, Inc. Family Medicine Current Accepting new patients
Statera Health Care, LLC Emergency Medicine CurrentSince Dec 15, 2022 Accepting new patients
Integritas Emergency Physician Services, LLC Emergency Medicine CurrentSince Dec 15, 2022 Accepting new patients
Deaconess Illinois Specialty Clinic, Inc. Family Medicine CurrentSince Jan 1, 2024 Accepting new patients
Deaconess Illinois Specialty Clinic, Inc. CurrentSince Jan 1, 2024 Accepting new patients
Southern Illinois Medical Services, NFP CurrentSince Sep 16, 2012 Accepting new patients

Locations

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

405 W Jackson St
Carbondale, IL 62901

305 W Jackson St
Ste 200
Carbondale, IL 62901
Phone (618) 453-3777

2250 N Illinois Ave
Carbondale, IL 62901
Phone (618) 833-1691

900 N Washington St
Du Quoin, IL 62832
Phone (618) 542-1050

303 S Commercial St
Harrisburg, IL 62946
Phone (618) 767-6050

100 Dr Warren Tuttle Dr
Harrisburg, IL 62946
Phone (618) 252-4956

201 S 14th St
Herrin, IL 62948
Phone (618) 942-2171

3333 W Deyoung St
Marion, IL 62959
Phone (618) 998-7020

611 S Marshall Ave
Mc Leansboro, IL 62859
Phone (618) 542-2146

8 Doctors Park Rd
Mount Vernon, IL 62864
Phone (618) 244-5500

2 S Hospital Dr
Murphysboro, IL 62966
Phone (618) 684-3156

818 E Broadway St
Sparta, IL 62286
Phone (618) 443-2177

Interoperability endpoints

  • Direct secure messaging: dshelton14242@sih.direct-ci.com

Organizations & group practices 6

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.

Hospital & facility affiliations 1

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": "1165968000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1632787200000",
    "number": "1346301025",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3988",
            "city": "CARBONDALE",
            "state": "IL",
            "postal_code": "629023988",
            "telephone_number": "618-457-5200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 S 14TH ST",
            "city": "HERRIN",
            "state": "IL",
            "postal_code": "62948",
            "telephone_number": "618-942-2171",
            "fax_number": "618-351-4917"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2 S Hospital Dr",
            "address_purpose": "LOCATION",
            "city": "Murphysboro",
            "state": "IL",
            "postal_code": "629663333",
            "country_code": "US",
            "telephone_number": "618-684-3156",
            "fax_number": "618-529-0524",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "305 W Jackson St",
            "address_2": "Suite 200",
            "address_purpose": "LOCATION",
            "city": "Carbondale",
            "state": "IL",
            "postal_code": "629011474",
            "country_code": "US",
            "telephone_number": "618-549-0721",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "305 W Jackson St",
            "address_2": "Suite 200",
            "address_purpose": "LOCATION",
            "city": "Carbondale",
            "state": "IL",
            "postal_code": "629011474",
            "country_code": "US",
            "telephone_number": "618-549-0721",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHELTON",
        "first_name": "DONNIE",
        "middle_name": "EDWIN",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-12-13",
        "last_updated": "2021-09-28",
        "certification_date": "2021-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "1250520017",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "IL",
            "license": "036121910",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "dshelton14242@sih.direct-ci.com",
            "affiliation": "N",
            "address_1": "201 S 14th St",
            "city": "Herrin",
            "state": "IL",
            "country_code": "US",
            "postal_code": "62948",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "dshelton14242@sih.direct-ci.com",
            "affiliation": "N",
            "address_1": "2 S Hospital Dr",
            "city": "Murphysboro",
            "state": "IL",
            "country_code": "US",
            "postal_code": "629663333",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "dshelton14242@sih.direct-ci.com",
            "affiliation": "N",
            "address_1": "405 W Jackson St",
            "city": "Carbondale",
            "state": "IL",
            "country_code": "US",
            "postal_code": "629011462",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Herrin, IL

Sources for this page

Verify at the official NPI Registry.