NPIMap

Organization Active NPI

ENT & Sleep Medicine Associates LLC

  • Otolaryngology Physician
  • Columbia, IL
National Provider Identifier
1376853994
Registry record updated Nov 3, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
036101869 Issued in IL
Legal business name
ENT & SLEEP MEDICINE ASSOCIATES LLC
Practice address
1000 Eleven S Ste 4F
Columbia, IL 62236-1080
Phone
(618) 628-0715
Fax
(888) 371-4468
NPI assigned
Oct 16, 2010
Last updated
Nov 3, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 3, 2020

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

Authorized official

Name
Kelli BlaggNPI 1679676738
Title
Business Manager
Phone
(618) 628-0715

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Y00000X 036101869 IL Primary
Sleep Medicine (Otolaryngology) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207YS0012X 036101869 IL

Addresses

Primary practice location

1000 Eleven S Ste 4F
Columbia, IL 62236-1080

Mailing address

1000 Eleven S Ste 4F
Columbia, IL 62236-1080
Phone (618) 628-0715

Other practice location 1

1926 Edwardsville Club Plaza Ct
Edwardsville, IL 62025-3717
Phone (618) 628-0715

Other practice location 2

1179 Fortune Blvd
Shiloh, IL 62269-7377
Phone (618) 628-0715

National Provider Directory

National Provider Directory

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Locations

1000 Eleven S
Ste 4F
Columbia, IL 62236

1179 Fortune Blvd
Shiloh, IL 62269
Phone (309) 368-8984

509 Hamacher St
Ste 205
Waterloo, IL 62298
Phone (618) 939-4368

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/JBIIBD

Practitioners & affiliated clinicians

Practitioners 11

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.

NPI Registry JSON

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

{
    "created_epoch": "1287187200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1604361600000",
    "number": "1376853994",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 ELEVEN S STE 4F",
            "city": "COLUMBIA",
            "state": "IL",
            "postal_code": "622361080",
            "telephone_number": "618-628-0715",
            "fax_number": "888-371-4468"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 ELEVEN S STE 4F",
            "city": "COLUMBIA",
            "state": "IL",
            "postal_code": "622361080",
            "telephone_number": "618-628-0715",
            "fax_number": "888-371-4468"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1926 Edwardsville Club Plaza Ct",
            "address_purpose": "LOCATION",
            "city": "Edwardsville",
            "state": "IL",
            "postal_code": "620253717",
            "country_code": "US",
            "telephone_number": "618-628-0715",
            "fax_number": "888-371-4468",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1179 Fortune Blvd",
            "address_purpose": "LOCATION",
            "city": "Shiloh",
            "state": "IL",
            "postal_code": "622697377",
            "country_code": "US",
            "telephone_number": "618-628-0715",
            "fax_number": "888-371-4468",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ENT & SLEEP MEDICINE ASSOCIATES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-10-16",
        "last_updated": "2020-11-03",
        "certification_date": "2020-11-03",
        "status": "A",
        "authorized_official_last_name": "BLAGG",
        "authorized_official_first_name": "KELLI",
        "authorized_official_title_or_position": "BUSINESS MANAGER",
        "authorized_official_telephone_number": "618-628-0715"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Otolaryngology",
            "state": "IL",
            "license": "036101869",
            "primary": true
        },
        {
            "code": "207YS0012X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Otolaryngology, Sleep Medicine",
            "state": "IL",
            "license": "036101869",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbia, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.