Individual provider Active NPI

Paul W Sutherland, MD

  • Surgery Physician
  • Olney, IL
National Provider Identifier
1649252511
Registry record updated Oct 28, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
036-060342 Issued in IL
Practice address
800 E Locust St
Olney, IL 62450-2553
Phone
(618) 395-7340
NPI assigned
Nov 16, 2005
Last updated
Oct 28, 2011By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 28, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
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

IdentifierTypeStateIssuer
0360603421MedicaidIL

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

LicenseStateTypeSpecialty
036-060342ILMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew 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.

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.

Verify at the official NPI Registry.