NPIMap

Individual provider Active NPI

Niranjan Shrestha, M.D., FAAFP

  • Family Medicine Physician
  • Centralia, IL
National Provider Identifier
1508031758
Registry record updated Oct 3, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
036.122701 Issued in IL
Practice address
1050 M L King Dr Ste 111
Centralia, IL 62801-3060
Phone
(618) 436-5237
Fax
(618) 436-5236
NPI assigned
Apr 29, 2008
Last updated
Oct 3, 2012By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 3, 2012

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 57009736 OH
Family Medicine Physician 207Q00000X 036.122701 IL Primary

Addresses

Primary practice location

1050 M L King Dr Ste 111
Centralia, IL 62801-3060

Mailing address

1050 M L King Dr Ste 111
Centralia, IL 62801-3060
Phone (618) 436-5237

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090914000592 IL Practitioner - Family PracticePractitioner - Emergency Medicine 1759437924 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

1050 M L King Dr
Centralia, IL 62801-3060
Phone (618) 436-5237

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as individual
Quality
100
Improvement activities
40
Cost
83.08

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036.122701ILMDFamily Medicine Physician
57009736OHMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Dr Shrestha MD SC CurrentSince Jan 2, 2012 Accepting new patients
Physician Services Corporation of Southern Illinois Inc. Family Medicine PastSince Jul 1, 2014 Accepting new patients

Locations

1050 Martin Luther King Dr
Ste 111
Centralia, IL 62801
Phone (618) 436-5237

Interoperability endpoints

  • Direct secure messaging: drshresthamdsc.niranjanshrestha@148222.advancedmd-direct.com
  • Direct secure messaging: nshrestha82054@direct-ehr-ssmhc.com

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 6

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": "1209427200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1349222400000",
    "number": "1508031758",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1050 M L KING DR STE 111",
            "city": "CENTRALIA",
            "state": "IL",
            "postal_code": "628013060",
            "telephone_number": "618-436-5237",
            "fax_number": "618-436-5236"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1050 M L KING DR STE 111",
            "city": "CENTRALIA",
            "state": "IL",
            "postal_code": "628013060",
            "telephone_number": "618-436-5237",
            "fax_number": "618-436-5236"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHRESTHA",
        "first_name": "NIRANJAN",
        "credential": "M.D., FAAFP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-04-29",
        "last_updated": "2012-10-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OH",
            "license": "57009736",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036.122701",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Centralia, IL

Sources for this page

Verify at the official NPI Registry.