Jitendra Trivedi, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

036057566 Issued in IL

Practice address

4218 Lincolnshire Dr
Mount Vernon, IL 62864-2156

Phone

(618) 899-3600

Fax

(618) 241-4810

NPI assigned

Aug 17, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Good Samaritan Regional Health Center

  • Community/Retail Pharmacy
  • Mount Vernon, IL
  • NPI 1316282163
  NPD (past)

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

{
    "created_epoch": "1155772800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1381449600000",
    "number": "1679687933",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4218 LINCOLNSHIRE DR",
            "city": "MOUNT VERNON",
            "state": "IL",
            "postal_code": "628642156",
            "telephone_number": "618-899-3600",
            "fax_number": "618-241-4810"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4218 LINCOLNSHIRE DR",
            "city": "MOUNT VERNON",
            "state": "IL",
            "postal_code": "628642156",
            "telephone_number": "618-899-3600",
            "fax_number": "618-241-4810"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TRIVEDI",
        "first_name": "JITENDRA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-17",
        "last_updated": "2013-10-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036057566",
            "primary": true
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "IL",
            "license": "036057566",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036057566",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Regina Ann Thompson, LCSW
• Amy L Tinsley, CADC
• Tyson Wayne Tinsley, D.M.D.
• Diana L Tomlianovich, PMHNP-BC
• Cynthia Travis, RN
• Kristie Turner, P.T.
• Crystal Tyson, OT
• United Cerebral Palsy of Southern Illinois,Inc.
• United Methodist Children'S Home of Southern Illinois Inc.
• United Skin Specialists Illinois LTD, PC

• Internal Medicine Physician in Mount Vernon, IL
• Providers in Mount Vernon, IL by specialty
• Internal Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2013; 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.