Momodou Sallah, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

85001515 Issued in IL

Practice address

2401 W Main St
Marion, IL 62959-1188

Phone

(618) 997-5311

NPI assigned

Aug 31, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: msallah@yourcarecommunity.org

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.

• Graham Hospital Association

  • Critical Access Hospital
  • Canton, IL
  • NPI 1780692087
  Medicare reassignment NPD
• Graham Hospital Association

  dba Graham Medical Group Galesburg 2

  • Rural Health Clinic/Center
  • Galesburg, IL
  • NPI 1063128601
  NPD
• Graham Hospital Association

  dba Knox & Fulton County Wound and Hyperbaric Medicine

  • Internal Medicine Physician
  • Galesburg, IL
  • NPI 1710845854
  NPD
• Illiana Emergency Physicians LLP

  • Emergency Medicine Physician
  • Greenville, IL
  • NPI 1730426941
  NPD (past)
• Illiana Emergency Physicians, LLP

  • Emergency Medicine Physician
  • Danville, IL
  • NPI 1164447058
  NPD (past)
• Kennekuk Emergency Physicians LLC

  • Emergency Medicine Physician
  • Danville, IL
  • NPI 1659523777
  NPD (past)
• Kirby Medical Center

  dba Kirby Rx

  • Community/Retail Pharmacy
  • Monticello, IL
  • NPI 1568074714
  NPD (past)
• Marion Emergency Physicians, LLC

  • Emergency Medicine Physician
  • Marion, IL
  • NPI 1679870513
  NPD (past)

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1249257600000",
    "number": "1598876617",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 DANIELLE CT",
            "city": "MARION",
            "state": "IL",
            "postal_code": "629591545",
            "telephone_number": "618-997-5311"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2401 W MAIN ST",
            "city": "MARION",
            "state": "IL",
            "postal_code": "629591188",
            "telephone_number": "618-997-5311"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SALLAH",
        "first_name": "MOMODOU",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-31",
        "last_updated": "2009-08-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "IL",
            "license": "85001515",
            "primary": true
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "IL",
            "license": "085001515",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Angela Marie Russell
• Brittney Russell
• Holly Roxanne Russell, DPT
• Aaron Joseph Ruzich
• Ali Salimi, MD
• Sam's West Inc (Sam's Pharmacy)
• Meshach Vedanayagam Samuel
• Amber Nicole Sanders
• Sarah Sanders, RN
• Teena Sanders, RN

• Medical Physician Assistant in Marion, IL
• Providers in Marion, IL by specialty
• Medical Physician Assistant in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.