Active NPI
Simrandeep Sandhu
- Family Medicine Physician
- Carbondale, IL
National Provider Identifier
1407747876
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 125085233
- Practice address
- 300 W Oak St Ste 200
Carbondale, IL 62901-1400 - Phone
- (618) 536-6621
- NPI assigned
- Jul 14, 2025
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 125085233 | IL | Primary |
Addresses
Primary practice location
300 W Oak St Ste 200
Carbondale, IL 62901-1400
Mailing address
300 W Oak St Ste 200
Carbondale, IL 62901-1400
Phone (618) 536-6621
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250812003354 | IL | Order and Referring Only - Family Practice | 4284132838 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1752451200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1766880000000",
"number": "1407747876",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "300 W OAK ST STE 200",
"city": "CARBONDALE",
"state": "IL",
"postal_code": "629011400",
"telephone_number": "618-536-6621",
"fax_number": "618-453-1102"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "300 W OAK ST STE 200",
"city": "CARBONDALE",
"state": "IL",
"postal_code": "629011400",
"telephone_number": "618-536-6621"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SANDHU",
"first_name": "SIMRANDEEP",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2025-07-14",
"last_updated": "2025-12-28",
"certification_date": "2025-12-28",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "IL",
"license": "125085233",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Carbondale, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.