Illinois-Indiana Em-I Medical Services S C

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

Legal business name

ILLINOIS-INDIANA EM-I MEDICAL SERVICES S C

Practice address

1400 W Park St
Urbana, IL 61801-2334

Phone

(217) 337-2000

Fax

(217) 337-2930

NPI assigned

Oct 21, 2008

Organization subpart

No

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

Authorized official

Name

Karen Marie Vaughn

Title

Ao

Phone

(404) 450-4684

Specialties & licenses 3

Addresses

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

{
    "created_epoch": "1224547200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1704326400000",
    "number": "1457503591",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 80175",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191011175",
            "telephone_number": "003-553-8188",
            "fax_number": "610-834-9292"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 W PARK ST",
            "city": "URBANA",
            "state": "IL",
            "postal_code": "618012334",
            "telephone_number": "217-337-2000",
            "fax_number": "217-337-2930"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ILLINOIS-INDIANA EM-I MEDICAL SERVICES S C",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-10-21",
        "last_updated": "2024-01-04",
        "certification_date": "2024-01-04",
        "status": "A",
        "authorized_official_last_name": "VAUGHN",
        "authorized_official_first_name": "KAREN",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "AO",
        "authorized_official_telephone_number": "404-450-4684"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Emergency Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2024; 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.