Individual provider Active NPI

Emmanuel Antony Amulraj, M.D

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • Temple, TX
National Provider Identifier
1407005176
Registry record updated Aug 5, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Thoracic Surgery (Cardiothoracic Vascular Surgery) PhysicianTaxonomy code 208G00000X
License
Q1077 Issued in TX
Practice address
2401 S 31St St
Temple, TX 76508-0001
Phone
(254) 724-2111
NPI assigned
Sep 17, 2008
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 5, 2015

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician 208G00000X 036117576 IL
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician 208G00000X Q1077 TX Primary

Addresses

Primary practice location

2401 S 31St St
Temple, TX 76508-0001

Mailing address

PO Box 844658
Dallas, TX 75284-4658
Phone (254) 724-8800

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
I20120727000611 IL Practitioner - Thoracic SurgeryPractitioner - General SurgeryPractitioner - Cardiac Surgery 9335305820 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Thoracic SurgeryAlso: Cardiac Surgery
Education
Other, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Osf Multi-Specialty GroupGroup PAC ID 3678889789, 2,123 clinicians

Practice addresses (Care Compare)

515 NE Glen Oak Ave
Peoria, IL 61603-3136
Phone (309) 674-2002

Hospital & facility affiliations

  • St. Francis Medical Center Home health agency, Peoria, IL, CCN 147243
  • Osf Healthcare Home Care Home health agency, Loves Park, IL, CCN 147271
  • Osf Home Health-Western Region Home health agency, Galesburg, IL, CCN 147430
  • Saint Francis Medical Center Hospital, Peoria, IL, CCN 140067
  • Osf Saint Elizabeth MDL Ctr Hospital, Peru, IL, CCN 140110
  • St Mary Medical Center Hospital, Galesburg, IL, CCN 140064
  • Graham Hospital Association Hospital, Canton, IL, CCN 141356
  • Osf Saint Clare Medical Center Hospital, Princeton, IL, CCN 141337

Procedures performed for Medicare patients

ProcedureNumber of procedures
Coronary artery bypass graft (CABG)14

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
56178CAMDOrthodontics and Dentofacial Orthopedic Dentist
Q1077TXMDThoracic Surgery (Cardiothoracic Vascular Surgery) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Central PA Pharmacy LLC. Current Accepting new patients
Osf Multi-Specialty Group CurrentSince Mar 15, 2018 Accepting new patients

Locations

515 NE Glen Oak Ave
Peoria, IL 61603
Phone (309) 624-7777

8600 State Route 91
Ste 130
Peoria, IL 61615
Phone (309) 683-5050

515 NE Glen Oak Ave
Ste 202
Peoria, IL 61603
Phone (309) 624-4455

Organizations & group practices 2

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 7

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": "1221609600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1438732800000",
    "number": "1407005176",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 844658",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752844658",
            "telephone_number": "254-724-8800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2401 S 31ST ST",
            "city": "TEMPLE",
            "state": "TX",
            "postal_code": "765080001",
            "telephone_number": "254-724-2111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AMULRAJ",
        "first_name": "EMMANUEL",
        "middle_name": "ANTONY",
        "name_prefix": "Dr.",
        "credential": "M.D",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-09-17",
        "last_updated": "2015-08-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208G00000X",
            "taxonomy_group": "",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": "IL",
            "license": "036117576",
            "primary": false
        },
        {
            "code": "208G00000X",
            "taxonomy_group": "",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": "TX",
            "license": "Q1077",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Temple, TX

Sources for this page

Verify at the official NPI Registry.