NPIMap

Individual provider Active NPI

Sudeep Nair, MD

  • Internal Medicine Physician
  • Mount Vernon, IL
National Provider Identifier
1376582999
Registry record updated Dec 1, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
036092998 Issued in IL
Practice address
602 S 42ND St
Suite B
Mount Vernon, IL 62864-6264
Phone
(618) 899-3777
Fax
(618) 242-2378
NPI assigned
Jun 6, 2006
Last updated
Dec 1, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 1, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 036092998 IL Primary

Addresses

Primary practice location

602 S 42ND St
Suite B
Mount Vernon, IL 62864-6264

Mailing address

602 S 42ND St
Suite B
Mount Vernon, IL 62864-6264
Phone (618) 899-3777

Other identifiers 4

IdentifierTypeStateIssuer
04108653OtherILBCBS
110143249OtherILRR MEDICARE
036092998MedicaidIL
CK7203OtherILRR GROUP NUMBER

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address snair76654@direct-ehr-ssmhc.com Direct
FHIR URL https://fhir.ssmhc.com/fhir/api/FHIR/DSTU2/ Other

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
I20060824000472 IL Practitioner - Internal Medicine 8325041775 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1991
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
Physician Services Corporation of Southern Illinois IncGroup PAC ID 9234022567, 120 clinicians

Practice addresses (Care Compare)

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

17884 Exchange Ave
Nashville, IL 62263-3418
Phone (618) 327-8486

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Physician Services Corporation of Southern Illinois Inc. Internal Medicine CurrentSince Oct 3, 2017 Accepting new patients

Locations

811 Fairfax St
Carlyle, IL 62231
Phone (618) 594-3025

1003 E McCord St
Centralia, IL 62801
Phone (618) 436-5231

7420 Solutions Ctr
Chicago, IL 60677
Phone (314) 989-3155

2 Good Samaritan Way
Ste 320
Mount Vernon, IL 62864
Phone (618) 899-1944

2 Good Samaritan Way
Ste 420
Mount Vernon, IL 62864
Phone (618) 899-4000

602 S 42nd St
#B
Mount Vernon, IL 62864
Phone (618) 899-3278

602 S 42nd St
Ste B
Mount Vernon, IL 62864
Phone (618) 899-3278

605 N 12th St
Mount Vernon, IL 62864
Phone (618) 241-2200

17884 Exchange Ave
Nashville, IL 62263
Phone (618) 327-8486

Interoperability endpoints

  • Direct secure messaging: snair76654@direct-ehr-ssmhc.com

Ownership & related parties

All facility ownership & control disclosures 5

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
SSM Health Good Samaritan Hospital - Mt. VernonMount Vernon, IL, CCN 140046 Hospital Corporate Director Dec 31, 2020
SSM Health St. Mary's Hospital-CentraliaCentralia, IL, CCN 14S034 Hospital Corporate Director Dec 31, 2020
SSM Health St. Mary's Hospital - CentraliaCentralia, IL, CCN 140034 Hospital Corporate Director Jan 1, 2022
SSM Health Good Samaritan Hospital - Mt VernonMount Vernon, IL, CCN 14T046 Hospital Corporate Director Dec 31, 2020
SSM Health Medical GroupCentralia, IL, CCN 783803 Rural health clinic Corporate Director Jan 1, 2019

Owned or controlled facilities with NPI records 5

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 1

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 9

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": "1149552000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1606780800000",
    "number": "1376582999",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "602 S 42ND ST",
            "address_2": "SUITE B",
            "city": "MOUNT VERNON",
            "state": "IL",
            "postal_code": "628646264",
            "telephone_number": "618-899-3777",
            "fax_number": "618-242-2378"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "602 S 42ND ST",
            "address_2": "SUITE B",
            "city": "MOUNT VERNON",
            "state": "IL",
            "postal_code": "628646264",
            "telephone_number": "618-899-3777",
            "fax_number": "618-242-2378"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NAIR",
        "first_name": "SUDEEP",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-06",
        "last_updated": "2020-12-01",
        "certification_date": "2020-12-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036092998",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "04108653",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "110143249",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036092998",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR GROUP NUMBER",
            "identifier": "CK7203",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "snair76654@direct-ehr-ssmhc.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "snair76654@direct-ehr-ssmhc.com",
            "address_1": "602 S 42nd St",
            "address_2": "Suite B",
            "city": "Mount Vernon",
            "state": "IL",
            "country_code": "US",
            "postal_code": "628646264",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://fhir.ssmhc.com/fhir/api/FHIR/DSTU2/",
            "affiliation": "N",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "FHIR API",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCD",
            "address_1": "602 S 42nd St",
            "address_2": "Suite B",
            "city": "Mount Vernon",
            "state": "IL",
            "country_code": "US",
            "postal_code": "628646264",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Mount Vernon, IL

Sources for this page

Verify at the official NPI Registry.