NPIMap

Individual provider Active NPI

Sara B Malone, MD

  • Family Medicine Physician
  • Carbondale, IL
National Provider Identifier
1386976298
Registry record updated May 11, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
036-124706 Issued in IL
Practice address
305 W Jackson St
Ste 200
Carbondale, IL 62901-1474
Phone
(618) 453-7777
Fax
(618) 453-1102
NPI assigned
Feb 2, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 11, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 036-124706 IL Primary

Addresses

Primary practice location

305 W Jackson St
Ste 200
Carbondale, IL 62901-1474

Mailing address

305 W Jackson St
Ste 200
Carbondale, IL 62901-1474
Phone (618) 453-7777

Other identifiers 1

IdentifierTypeStateIssuer
036124706MedicaidIL

Other names 1

  • Sara B Dusch Former name

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
I20100430000458 IL Practitioner - Family Practice 0547397135 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Select Physical Therapy Holdings IncGroup PAC ID 9537076401, shared by 76 NPIs, 1,992 clinicians

Practice addresses (Care Compare)

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

2553 Ken Gray Blvd
W Frankfort, IL 62896-4174
Phone (618) 932-2155

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036-124706ILMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Southern Illinois Hospital Services Current Accepting new patients
Siu Physicians & Surgeons, Inc CurrentSince Feb 15, 2010 Accepting new patients
Board of Trustees of Southern Illinois University CurrentSince Feb 17, 2021 Accepting new patients
Southern Illinois Hospital Services Family Medicine CurrentSince Dec 1, 2016 Accepting new patients
Board of Trustees of Southern Illinois University CurrentSince Feb 17, 2021 Accepting new patients
Southern Illinois Hospital Services CurrentSince Dec 1, 2016 Accepting new patients
Siu Physicians & Surgeons, Inc Family Medicine CurrentSince Feb 15, 2010 Accepting new patients
Board of Trustees of Southern Illinois University Family Medicine Current Accepting new patients

Locations

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

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

520 N 4th St
Springfield, IL 62702
Phone (217) 757-8100

2553 Ken Gray Blvd
West Frankfort, IL 62896
Phone (618) 932-2155

Interoperability endpoints

  • Direct secure messaging: smalone15457@sih.direct-ci.com

Organizations & group practices 8

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 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": "1265068800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1273536000000",
    "number": "1386976298",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "305 W JACKSON ST",
            "address_2": "STE 200",
            "city": "CARBONDALE",
            "state": "IL",
            "postal_code": "629011474",
            "telephone_number": "618-453-7777",
            "fax_number": "618-453-1102"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "305 W JACKSON ST",
            "address_2": "STE 200",
            "city": "CARBONDALE",
            "state": "IL",
            "postal_code": "629011474",
            "telephone_number": "618-453-7777",
            "fax_number": "618-453-1102"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MALONE",
        "first_name": "SARA",
        "middle_name": "B",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-02-02",
        "last_updated": "2010-05-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036-124706",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036124706",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SARA",
            "last_name": "DUSCH",
            "middle_name": "B",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Carbondale, IL

Sources for this page

Verify at the official NPI Registry.