Individual provider Active NPI

Thomas Michael Hulsen, M.D.

  • Obstetrics & Gynecology Physician
  • Maryville, IL
National Provider Identifier
1417060542
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
Practice address
6810 State Route 162
Suite 301
Maryville, IL 62062-8501
Phone
(618) 288-5699
NPI assigned
Aug 15, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X IL Primary

Addresses

Primary practice location

6810 State Route 162
Suite 301
Maryville, IL 62062-8501

Mailing address

6810 State Route 162
Suite 301
Maryville, IL 62062-8501
Phone (618) 288-5699

Other identifiers 1

IdentifierTypeStateIssuer
0361097571MedicaidIL

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
I20031223000468 IL Practitioner - Obstetrics/Gynecology 5597663864 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Obstetrics/Gynecology
Education
University of Missouri, Columbia School of Medicine, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Anderson Medical Group LLCGroup PAC ID 5193792018, 136 clinicians

Practice addresses (Care Compare)

6810 State Route 162
Suite 105
Maryville, IL 62062-8560
Phone (618) 288-9320

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036-109757ILMDObstetrics & Gynecology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
James J. Dalla Riva, MD, PC CurrentSince Aug 6, 2003 Accepting new patients
Anderson Medical Group, LLC Obstetrics & Gynecology CurrentSince Jul 1, 2025 Accepting new patients
Ozarks Medical Center Past Accepting new patients

Locations

6810 State Route 162
Ste 301
Maryville, IL 62062
Phone (618) 288-2970

6810 State Route 162
Ste 105
Maryville, IL 62062
Phone (618) 288-3616

6812 State Route 162
Ste 303
Maryville, IL 62062
Phone (618) 288-9320

6810 State Route 162
Ste 215
Maryville, IL 62062
Phone (618) 391-6405

6812 State Route 162
Ste 301
Maryville, IL 62062
Phone (618) 288-5699

Organizations & group practices 3

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": "1155600000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1417060542",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6810 STATE ROUTE 162",
            "address_2": "SUITE 301",
            "city": "MARYVILLE",
            "state": "IL",
            "postal_code": "620628501",
            "telephone_number": "618-288-5699"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6810 STATE ROUTE 162",
            "address_2": "SUITE 301",
            "city": "MARYVILLE",
            "state": "IL",
            "postal_code": "620628501",
            "telephone_number": "618-288-5699"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HULSEN",
        "first_name": "THOMAS",
        "middle_name": "MICHAEL",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-15",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0361097571",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Maryville, IL

Sources for this page

Verify at the official NPI Registry.