Individual provider Active NPI

Keisha Leshon Powell, M.D.

  • Psychiatry Physician
  • Springfield, IL
National Provider Identifier
1396184446
Registry record updated Jun 9, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
036.140456 Issued in IL
Practice address
319 E Madison St FL 3
Springfield, IL 62701
Phone
(217) 545-8000
Fax
(217) 545-2275
NPI assigned
Jun 21, 2013
Last updated
Jun 9, 2018By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 9, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X 036.140456 IL Primary
Child & Adolescent Psychiatry Physician 2084P0804X 036-140456 IL

Addresses

Primary practice location

319 E Madison St FL 3
Springfield, IL 62701

Mailing address

PO Box 19642
Springfield, IL 62794-9642
Phone (217) 545-8000

Other identifiers 1

IdentifierTypeStateIssuer
036-140456OtherILSTATE LICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
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 1

Enrollment IDStateProvider typePAC IDDetails
I20180702000087 IL Practitioner - Psychiatry 9830495142 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
Southern Illinois University School of Medicine, 2013
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

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
036.140456ILMDPsychiatry Physician
036-140456ILMDChild & Adolescent Psychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Siu Physicians & Surgeons, Inc CurrentSince Jul 2, 2018 Accepting new patients
Board of Trustees of Southern Illinois University Current Accepting new patients
Siu Physicians & Surgeons, Inc Psychiatry CurrentSince Jul 2, 2018 Accepting new patients
Board of Trustees of Southern Illinois University Past Accepting new patients

Locations

319 E Madison St
Fl 3
Springfield, IL 62701
Phone (217) 545-7627

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

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

Interoperability endpoints

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

Organizations & group practices 5

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 1

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": "1371772800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1528502400000",
    "number": "1396184446",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 19642",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627949642",
            "telephone_number": "217-545-8000",
            "fax_number": "217-545-2275"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "319 E MADISON ST FL 3",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "62701",
            "telephone_number": "217-545-8000",
            "fax_number": "217-545-2275"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POWELL",
        "first_name": "KEISHA",
        "middle_name": "LESHON",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-06-21",
        "last_updated": "2018-06-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "IL",
            "license": "036.140456",
            "primary": true
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "IL",
            "license": "036-140456",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "036-140456",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Springfield, IL

Sources for this page

Verify at the official NPI Registry.