NPIMap

Individual provider Active NPI

Vidya Sundareshan, MD

  • Infectious Disease Physician
  • Springfield, IL
National Provider Identifier
1376790733
Registry record updated Jan 21, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Infectious Disease PhysicianTaxonomy code 207RI0200X
License
036-121672 Issued in IL
Practice address
751 N Rutledge St
Suite 1100
Springfield, IL 62702-4909
Phone
(217) 545-9537
Fax
(217) 545-8025
NPI assigned
Aug 27, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 21, 2010

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 036-121672 IL
Infectious Disease Physician 207RI0200X 036-121672 IL Primary

Addresses

Primary practice location

751 N Rutledge St
Suite 1100
Springfield, IL 62702-4909

Mailing address

PO Box 19636
Springfield, IL 62794-9636
Phone (217) 545-9537

Other identifiers 1

IdentifierTypeStateIssuer
036121672MedicaidIL

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
I20081018000141 IL Practitioner - Infectious Disease 7315005444 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Infectious Disease
Education
Other, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Siu Physicians and Surgeons IncGroup PAC ID 2365352820, 316 clinicians

Practice addresses (Care Compare)

751 N Rutledge St
Springfield, IL 62702-4968
Phone (217) 545-8000

Hospital & facility affiliations

  • St Johns Hospital Hospital, Springfield, IL, CCN 140053
  • Memorial Medical Center Hospital, Springfield, IL, CCN 140148
  • St Anthonys Memorial Hospital Hospital, Effingham, IL, CCN 140032
  • Decatur Memorial Hospital Hospital, Decatur, IL, CCN 140135
  • Pana Community Hospital Hospital, Pana, IL, CCN 141341

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as group

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036-121672ILMDInfectious Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Siu Physicians & Surgeons, Inc CurrentSince Sep 1, 2008 Accepting new patients
Board of Trustees of Southern Illinois University Current Accepting new patients
Siu Physicians & Surgeons, Inc Internal Medicine CurrentSince Sep 1, 2008 Accepting new patients
Gibson Community Hospital Association Past Accepting new patients

Locations

751 N Rutledge St
Springfield, IL 62702
Phone (217) 545-0182

751 N Rutledge St
Ste 1100
Springfield, IL 62702
Phone (217) 545-0182

Interoperability endpoints

  • Direct secure messaging: vidyasundareshan@siusm.allscriptsdirect.net

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 and National Provider Directory roles.

Hospital & facility affiliations 6

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": "1219795200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1264032000000",
    "number": "1376790733",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 19636",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627949636",
            "telephone_number": "217-545-9537",
            "fax_number": "217-545-8025"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "751 N RUTLEDGE ST",
            "address_2": "SUITE 1100",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627024909",
            "telephone_number": "217-545-9537",
            "fax_number": "217-545-8025"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUNDARESHAN",
        "first_name": "VIDYA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-08-27",
        "last_updated": "2010-01-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036-121672",
            "primary": false
        },
        {
            "code": "207RI0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Infectious Disease",
            "state": "IL",
            "license": "036-121672",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036121672",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Springfield, IL

Sources for this page

Verify at the official NPI Registry.