Active NPI
Susan Sheppard
- Family Medicine Physician
- Normal, IL
National Provider Identifier
1598857278
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 036101712
- Practice address
- 2200 Fort Jesse Rd
Suite 110
Normal, IL 61761-6286 - Phone
- (309) 661-6290
- Fax
- (309) 451-1354
- NPI assigned
- Sep 29, 2006
- Last updated
- Jun 10, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 036101712 | IL | Primary |
Addresses
Primary practice location
2200 Fort Jesse Rd
Suite 110
Normal, IL 61761-6286
Mailing address
2200 Fort Jesse Rd
Suite 110
Normal, IL 61761-6286
Phone (309) 661-6290
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 833130 | Other | IL | MEDICARE GROUP # |
| 036101712 | Medicaid | IL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Hospital & Medical Foundation of Paris, Inc. | Family Medicine | Past | Accepting new patients |
Organizations & group practices 1
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.
-
dba Horizon Health
- Clinic/Center
- Paris, IL
- NPI 1629280367
Family Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159488000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1213056000000",
"number": "1598857278",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2200 FORT JESSE RD",
"address_2": "SUITE 110",
"city": "NORMAL",
"state": "IL",
"postal_code": "617616286",
"telephone_number": "309-661-6290",
"fax_number": "309-451-1354"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2200 FORT JESSE RD",
"address_2": "SUITE 110",
"city": "NORMAL",
"state": "IL",
"postal_code": "617616286",
"telephone_number": "309-661-6290",
"fax_number": "309-451-1354"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHEPPARD",
"first_name": "SUSAN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-09-29",
"last_updated": "2008-06-10",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "IL",
"license": "036101712",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE GROUP #",
"identifier": "833130",
"state": "IL"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "036101712",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Normal, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.