Gastroenterology Care of Southern Illinois, LLC

Primary specialty

Gastroenterology PhysicianTaxonomy code 207RG0100X

License

036-073571 Issued in IL

Legal business name

GASTROENTEROLOGY CARE OF SOUTHERN ILLINOIS, LLC

Doing business as

Sushilkumar Tibrewala, MD

Practice address

3301 Patriot CT
Herrin, IL 62948-3782

Phone

(618) 998-8885

Fax

(618) 998-8886

NPI assigned

Feb 4, 2007

Last updated

Jul 4, 2025By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Sushilkunar Mahabirprasad Tibrewala, M.D.

Title

President

Phone

(618) 998-8885

Specialties & licenses 1

Addresses

Other identifiers 5

Other names 1

• Sushilkumar Tibrewala, MD Doing business as

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Sushilkumar Mahabirprasad Tibrewala, M.D.

  • Gastroenterology Physician
  • Herrin, IL
  • NPI 1457366858
  Medicare reassignment Care Compare group NPD
• Robin Gallo, PA-C

  • Physician Assistant
  • Herrin, IL
  • NPI 1497869440
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1170547200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1751587200000",
    "number": "1609914183",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24 PINE LAKE DR",
            "city": "CARBONDALE",
            "state": "IL",
            "postal_code": "629015410",
            "telephone_number": "618-534-1935",
            "fax_number": "618-998-8886"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3301 PATRIOT CT",
            "city": "HERRIN",
            "state": "IL",
            "postal_code": "629483782",
            "telephone_number": "618-998-8885",
            "fax_number": "618-998-8886"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GASTROENTEROLOGY CARE OF SOUTHERN ILLINOIS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-04",
        "last_updated": "2025-07-04",
        "certification_date": "2025-07-04",
        "status": "A",
        "authorized_official_last_name": "TIBREWALA",
        "authorized_official_first_name": "SUSHILKUNAR",
        "authorized_official_middle_name": "MAHABIRPRASAD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "618-998-8885",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "IL",
            "license": "036-073571",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH ALLIANCE",
            "identifier": "046565",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036073571",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHLINK PPO",
            "identifier": "173109",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "833199720",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF IL",
            "identifier": "0010023397",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sushilkumar Tibrewala, MD",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Sushilkumar Tibrewala, MD",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Ginger Leigh Funk, PT
• Robin Gallo, PA-C
• Gunnar M Galloway
• Tamela Gamble, RPH
• Joana Caldeo Garcia
• Leon Gauthier, PA-C
• Chanavia Marquetta Givens
• Terrence Glennon, MD
• Macy Lane Goins, NP
• Robert J Golz, MD

• Gastroenterology Physician in Herrin, IL
• Providers in Herrin, IL by specialty
• Gastroenterology Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 4, 2025; 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.

Verify at the official NPI Registry.