Individual provider Active NPI

Haneme Idrizi, M.D.

  • Pediatrics Physician
  • Springfield, IL
National Provider Identifier
1649215344
Registry record updated Jun 27, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
036-146308 Issued in IL
Practice address
415 N 9TH St
Springfield, IL 62702
Phone
(217) 545-8000
Fax
(217) 757-6654
NPI assigned
Jun 17, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 27, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 036-146308 IL Primary

Addresses

Primary practice location

415 N 9TH St
Springfield, IL 62702

Mailing address

PO Box 19661
Springfield, IL 62794-9661
Phone (217) 545-8000

Other practice location 1

1033 Dr Martin Luther King Jr St N
Suite 108
St Petersburg, FL 33701-1547
Phone (727) 456-3288

Other identifiers 1

IdentifierTypeStateIssuer
036-146308OtherILSTATE LICENSE

Medicare participation

Medicare enrollment files
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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180814002515 IL Practitioner - Pediatric Medicine 4082875273 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036-146308ILMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Siu Physicians & Surgeons, Inc CurrentSince Jul 2, 2018 Accepting new patients
Siu Physicians & Surgeons, Inc CurrentSince Jul 2, 2018 Accepting new patients

Locations

415 N 9th St
Springfield, IL 62702
Phone (217) 545-5117

751 N Rutledge St
Springfield, IL 62702
Phone (217) 545-0182

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1150502400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1530057600000",
    "number": "1649215344",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 19661",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627949661",
            "telephone_number": "217-545-8000",
            "fax_number": "217-757-6654"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "415 N 9TH ST",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "62702",
            "telephone_number": "217-545-8000",
            "fax_number": "217-757-6654"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1033 Dr Martin Luther King Jr St N",
            "address_2": "Suite 108",
            "address_purpose": "LOCATION",
            "city": "St Petersburg",
            "state": "FL",
            "postal_code": "337011547",
            "country_code": "US",
            "telephone_number": "727-456-3288",
            "fax_number": "727-456-3289",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "IDRIZI",
        "first_name": "HANEME",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-17",
        "last_updated": "2018-06-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IL",
            "license": "036-146308",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "036-146308",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Springfield, IL

Sources for this page

Verify at the official NPI Registry.