Southern Illinois Family Medicine Corporation

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

036114185 Issued in IL

Legal business name

SOUTHERN ILLINOIS FAMILY MEDICINE CORPORATION

Practice address

104 Magnolia Dr Ste a
Glen Carbon, IL 62034-1595

Phone

(618) 288-9466

NPI assigned

Aug 4, 2006

Organization subpart

No

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

Authorized official

Name

Jim Hong, MDNPI 1487662656

Title

Owner

Phone

(618) 288-9466

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jim Hong, MD

  • Family Medicine Physician
  • Glen Carbon, IL
  • NPI 1487662656
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1154649600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1517443200000",
    "number": "1629086806",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "104 MAGNOLIA DR STE A",
            "city": "GLEN CARBON",
            "state": "IL",
            "postal_code": "620341595",
            "telephone_number": "618-288-9466"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 MAGNOLIA DR STE A",
            "city": "GLEN CARBON",
            "state": "IL",
            "postal_code": "620341595",
            "telephone_number": "618-288-9466"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN ILLINOIS FAMILY MEDICINE CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-04",
        "last_updated": "2018-02-01",
        "status": "A",
        "authorized_official_last_name": "HONG",
        "authorized_official_first_name": "JIM",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "618-288-9466",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036114185",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Family Medicine Physician in Glen Carbon, IL
• Providers in Glen Carbon, IL by specialty
• Family Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2018; 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.