NPIMap

Organization Active NPI

Si Medical, Inc.

  • Primary Care Nurse Practitioner
  • Marion, IL
National Provider Identifier
1659632602
Registry record updated May 20, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Nurse PractitionerTaxonomy code 363LP2300X
License
209.005527 Issued in IL
Legal business name
SI MEDICAL, INC.
Practice address
1909 W Coolidge Ave
Marion, IL 62959-1097
Phone
(618) 997-5677
Fax
(618) 998-1451
NPI assigned
Jun 6, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 20, 2014

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

Authorized official

Name
Ms. Tracy Askari
Title
Vice President
Phone
(618) 993-6641

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Metabolic Nutrition Registered DietitianGroup: 193200000X MULTI-SPECIALTY GROUP 133VN1006X 164.003714 IL
Medical Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363AM0700X 85.003452 IL
Primary Care Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LP2300X 209.002243 IL
Primary Care Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LP2300X 209.005527 IL Primary

Addresses

Primary practice location

1909 W Coolidge Ave
Marion, IL 62959-1097

Mailing address

1909 W Coolidge Ave
Marion, IL 62959-1097
Phone (618) 997-5677

National Provider Directory

National Provider Directory
Tax ID family
Si Medical Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 6

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

NPI Registry JSON

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

{
    "created_epoch": "1338940800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1400544000000",
    "number": "1659632602",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1909 W COOLIDGE AVE",
            "city": "MARION",
            "state": "IL",
            "postal_code": "629591097",
            "telephone_number": "618-997-5677",
            "fax_number": "618-998-1451"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1909 W COOLIDGE AVE",
            "city": "MARION",
            "state": "IL",
            "postal_code": "629591097",
            "telephone_number": "618-997-5677",
            "fax_number": "618-998-1451"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SI MEDICAL, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-06-06",
        "last_updated": "2014-05-20",
        "status": "A",
        "authorized_official_last_name": "ASKARI",
        "authorized_official_first_name": "TRACY",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "618-993-6641",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "133VN1006X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dietitian, Registered, Nutrition, Metabolic",
            "state": "IL",
            "license": "164.003714",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant, Medical",
            "state": "IL",
            "license": "85.003452",
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "IL",
            "license": "209.002243",
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "IL",
            "license": "209.005527",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Marion, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2014; 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.