Carly L Galli, FNP
Individual provider Active NPI Nurse Practitioner · Shiloh, IL
NPI 1669145686 · NPPES record last updated Jan 17, 2023
Key facts
- NPI
- 1669145686
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Nurse Practitioner 363L00000X
- License
- 209021624 (IL)
- Practice address
- 1414 Cross St Ste 240
Shiloh, IL 62269-2988 - Phone
- (618) 234-2390
- NPI assigned
- Jul 26, 2021
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20211014000722 | IL | Practitioner - Nurse Practitioner | 6305244807 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 209021624 | IL | MD | Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Fairview Heights Medical Group SC | Current |
Accepting new patients | |
| Fairview Heights Medical Group SC | Current | Accepting new patients |
Locations
1 Memorial Dr
Alton, IL 62002
Phone (618) 463-7240
1414 Cross St
Ste 240
Shiloh, IL 62269
Phone (618) 234-2390
1414 Cross St
Ste 210
Shiloh, IL 62269
Phone (618) 607-1260
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 209021624 | IL | |
| Nurse Practitioner | 363L00000X | 209021624 | IL | Yes |
Addresses
Primary practice location
1414 Cross St Ste 240
Shiloh, IL 62269-2988
Mailing address
1414 Cross St Ste 240
Shiloh, IL 62269-2988
Phone (618) 234-2390
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| FHIR URL | https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/ | Health Information Exchange (HIE) |
Other providers in Shiloh, IL
- Lauren Taylor Flint
- Shannon Lynn Franco
- Kharynn Friesland
- Danielle Lynn Frueh
- Andrew M Gaillardetz
- Robert W Garner
- Elizabeth Anne George
- Janet Glasper
- Michelle Gonzalez
- Alfred O Greco
All providers in Shiloh, IL · Nurse Practitioner in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 17, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.