Active NPI
Paul W Sutherland, MD
- Surgery Physician
- Olney, IL
National Provider Identifier
1649252511
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- 036-060342
- Practice address
- 800 E Locust St
Olney, IL 62450-2553 - Phone
- (618) 395-7340
- NPI assigned
- Nov 16, 2005
- Last updated
- Oct 28, 2011
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Surgery Physician | 208600000X | 036-060342 | IL | Primary |
Addresses
Primary practice location
800 E Locust St
Olney, IL 62450-2553
Mailing address
PO Box 97
Olney, IL 62450-0097
Phone (618) 395-7340
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0360603421 | 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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036-060342 | IL | MD | Surgery Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Richland Memorial Hospital, Inc | 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 RMH Professional Services
- Otolaryngology Physician
- East Alton, IL
- NPI 1104093590
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1132099200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1319760000000",
"number": "1649252511",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 97",
"city": "OLNEY",
"state": "IL",
"postal_code": "624500097",
"telephone_number": "618-395-7340"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "800 E LOCUST ST",
"city": "OLNEY",
"state": "IL",
"postal_code": "624502553",
"telephone_number": "618-395-7340"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SUTHERLAND",
"first_name": "PAUL",
"middle_name": "W",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-11-16",
"last_updated": "2011-10-28",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "IL",
"license": "036-060342",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0360603421",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Olney, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.