Individual provider Active NPI

Sumera Yaqub, M.D.

  • Internal Medicine Physician
  • Evansville, IN
National Provider Identifier
1356653463
Registry record updated Jun 26, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
FY5568019 Issued in IN
Practice address
3700 Washington Ave
Evansville, IN 47714-0541
Phone
(812) 485-7040
Fax
(812) 485-7042
NPI assigned
Jul 6, 2010
Last updated
Jun 26, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 26, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X FY5568019 IN Primary
Internal Medicine Physician 207R00000X 2010014300 MO

Addresses

Primary practice location

3700 Washington Ave
Evansville, IN 47714-0541

Mailing address

12101 Woodcrest Executive Dr Ste 210
Saint Louis, MO 63141-5047
Phone (314) 317-0600

Other practice location 1

12303 De Paul Dr
Bridgeton, MO 63044-2512
Phone (314) 317-0600

Other practice location 2

12303 De Paul Dr
Bridgeton, MO 63044-2512
Phone (314) 317-0600

Other identifiers 1

IdentifierTypeStateIssuer
1356653463MedicaidMO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO, IN2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20151027002580 MO Practitioner - Internal Medicine 8022327378 Reassigns benefits to 2 organizations
I20250703003681 IN Practitioner - Internal Medicine 8022327378 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St Marys Medical Group LLCGroup PAC ID 1153493341, 230 clinicians

Practice addresses (Care Compare)

3700 Washington Ave
Evansville, IN 47714-0541
Phone (812) 485-4000

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2010014300MOMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Southeastern Physician Services PC Internal Medicine CurrentSince Jul 1, 2016 Accepting new patients
St Mary's Medical Group, LLC Internal Medicine CurrentSince Jun 9, 2025 Accepting new patients
St Mary's Medical Group, LLC CurrentSince Jun 9, 2025 Accepting new patients

Locations

1116 Millis Ave
Boonville, IN 47601
Phone (812) 897-4800

3700 Washington Ave
Evansville, IN 47714
Phone (812) 232-0021

801 Saint Marys Dr
Ste 505E
Evansville, IN 47714
Phone (812) 491-3236

250 W 96th St
#520
Indianapolis, IN 46260
Phone (317) 583-3331

12303 De Paul Dr
Bridgeton, MO 63044
Phone (314) 344-6360

12380 De Paul Dr
Bridgeton, MO 63044
Phone (314) 447-9700

10 Hospital Dr
Saint Peters, MO 63376
Phone (636) 394-2522

Interoperability endpoints

  • Direct secure messaging: sumera.yaqub.p1@direct.phcenters.nextgenshare.com

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 2

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": "1278374400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1750896000000",
    "number": "1356653463",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12101 WOODCREST EXECUTIVE DR STE 210",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631415047",
            "telephone_number": "314-317-0600",
            "fax_number": "314-317-0606"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3700 WASHINGTON AVE",
            "city": "EVANSVILLE",
            "state": "IN",
            "postal_code": "477140541",
            "telephone_number": "812-485-7040",
            "fax_number": "812-485-7042"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "12303 De Paul Dr",
            "address_purpose": "LOCATION",
            "city": "Bridgeton",
            "state": "MO",
            "postal_code": "630442512",
            "country_code": "US",
            "telephone_number": "314-317-0600",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "12303 De Paul Dr",
            "address_purpose": "LOCATION",
            "city": "Bridgeton",
            "state": "MO",
            "postal_code": "630442512",
            "country_code": "US",
            "telephone_number": "314-317-0600",
            "fax_number": "314-317-0606",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "YAQUB",
        "first_name": "SUMERA",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-07-06",
        "last_updated": "2025-06-26",
        "certification_date": "2025-06-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IN",
            "license": "FY5568019",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MO",
            "license": "2010014300",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1356653463",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Evansville, IN

Sources for this page

Verify at the official NPI Registry.