NPIMap

Organization Active NPI

Select Psychiatric Management Group LLC

  • Psychiatry Physician
  • Harrisburg, IL
National Provider Identifier
1427345131
Registry record updated Jul 1, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
SELECT PSYCHIATRIC MANAGEMENT GROUP LLC
Practice address
100 Dr Warren Tuttle Dr
Harrisburg, IL 62946-2718
Phone
(618) 252-0999
Fax
(618) 252-2032
NPI assigned
Jul 1, 2011
Last updated
Jul 1, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 1, 2011

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

Authorized official

Name
Dr. Naeem Akhtar Qureshi, MD
Title
Member Manager
Phone
(618) 998-0888

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X IL Primary

Addresses

Primary practice location

100 Dr Warren Tuttle Dr
Harrisburg, IL 62946-2718

Mailing address

112 Airway Dr
Marion, IL 62959-5841
Phone (618) 998-0888

Other identifiers 1

IdentifierTypeStateIssuer
036094666MedicaidIL

National Provider Directory

National Provider Directory

Locations

112 Airway Dr
Marion, IL 62959
Phone (618) 988-0888

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1309478400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1309478400000",
    "number": "1427345131",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "112 AIRWAY DR",
            "city": "MARION",
            "state": "IL",
            "postal_code": "629595841",
            "telephone_number": "618-998-0888",
            "fax_number": "618-993-1808"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 DR WARREN TUTTLE DR",
            "city": "HARRISBURG",
            "state": "IL",
            "postal_code": "629462718",
            "telephone_number": "618-252-0999",
            "fax_number": "618-252-2032"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SELECT PSYCHIATRIC MANAGEMENT GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-07-01",
        "last_updated": "2011-07-01",
        "status": "A",
        "authorized_official_last_name": "QURESHI",
        "authorized_official_first_name": "NAEEM",
        "authorized_official_middle_name": "AKHTAR",
        "authorized_official_title_or_position": "MEMBER MANAGER",
        "authorized_official_telephone_number": "618-998-0888",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036094666",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Harrisburg, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.