Active NPI
Southern Illinois Heart and Vascular Center, PC
- Cardiovascular Disease Physician
- Mt. Vernon, IL
National Provider Identifier
1497984389
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Cardiovascular Disease Physician
- License
- 036123701
- Legal business name
- SOUTHERN ILLINOIS HEART AND VASCULAR CENTER, PC
- Practice address
- 4115 South Water Tower Place
Mt. Vernon, IL 62864-6293 - Phone
- (941) 735-8419
- NPI assigned
- Jul 13, 2009
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Fadi Michel Shamsham, M.D.
- Title
- President
- Phone
- (941) 735-8419
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Cardiovascular Disease Physician | 207RC0000X | 036123701 | IL | Primary |
Addresses
Primary practice location
4115 South Water Tower Place
Mt. Vernon, IL 62864-6293
Mailing address
P.O.Box 1003
Mt. Vernon, IL 62864-6293
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20090911000272 | IL | Part B Supplier - Clinic/Group Practice | 4880749027 |
Receives reassigned benefits from 4 practitioners Practice locations: Mount Vernon, IL |
National Provider Directory
National Provider DirectoryLocations
4115 S Water Tower Pl
Mount Vernon, IL 62864
Phone (618) 204-5462
Interoperability endpoints
- https://fhir4.healow.com/fhir/r4/JBDGCA
Practitioners & affiliated clinicians
Practitioners 5
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Interventional Cardiology Physician
- Mt. Vernon, IL
- NPI 1942203971
Cardiovascular Disease, IL
-
- Interventional Cardiology Physician
- Springfield, IL
- NPI 1528228624
Cardiovascular Disease, IL
-
- Cardiovascular Disease Physician
- Mount Vernon, IL
- NPI 1235309527
Cardiovascular Disease
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1247443200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1247443200000",
"number": "1497984389",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "P.O.BOX 1003",
"city": "MT. VERNON",
"state": "IL",
"postal_code": "628646293"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4115 SOUTH WATER TOWER PLACE",
"city": "MT. VERNON",
"state": "IL",
"postal_code": "628646293",
"telephone_number": "941-735-8419"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "SOUTHERN ILLINOIS HEART AND VASCULAR CENTER, PC",
"organizational_subpart": "NO",
"enumeration_date": "2009-07-13",
"last_updated": "2009-07-13",
"status": "A",
"authorized_official_last_name": "SHAMSHAM",
"authorized_official_first_name": "FADI",
"authorized_official_middle_name": "MICHEL",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "941-735-8419",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "M.D."
},
"taxonomies": [
{
"code": "207RC0000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Internal Medicine, Cardiovascular Disease",
"state": "IL",
"license": "036123701",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mt. Vernon, IL
- Jonathan L Sorenson, CRNA
- Southern Illinois Acute Care Consultants,LTD
- Southern Illinois Anesthesiology LTD
- Southern Illinois Consultants for Kidney Disease, S.C.
- Southern Illinois Family Foot Care, LLC
- Southside Medical Clinic Inc
- Spero Family Services
- Spero Family Services
- Spero Family Services
- Spero Family Services
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.