NPIMap

Organization Active NPI

Southern Illinois Healthcare Foundation, Inc.

Doing business as Cahokia School Based Center

  • School Nurse Practitioner
  • Cahokia, IL
National Provider Identifier
1689739062
Registry record updated Sep 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
School Nurse PractitionerTaxonomy code 363LS0200X
Legal business name
SOUTHERN ILLINOIS HEALTHCARE FOUNDATION, INC.
Doing business as
Cahokia School Based Center
Practice address
800 Range LN
Cahokia, IL 62206-2022
Phone
(618) 337-3117
Fax
(618) 337-3122
NPI assigned
Dec 26, 2006
Last updated
Sep 11, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2025

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

Authorized official

Name
Mr. Larry McCulley
Title
Chief Operating Officer
Phone
(618) 332-0783

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X
School Nurse Practitioner 363LS0200X Primary

Addresses

Primary practice location

800 Range LN
Cahokia, IL 62206-2022

Mailing address

8080 State St
East Saint Louis, IL 62203-1808
Phone (618) 397-3303

Other names 1

  • Cahokia School Based Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031126000641 IL Part B Supplier - Clinic/Group Practice 1456256874 Receives reassigned benefits from 170 practitioners
This NPI is an additional NPI on the enrollment
Practice locations: East Saint Louis, IL; Effingham, IL; Fairmont City, IL; Glen Carbon, IL; Granite City, IL; Greenup, IL; Mattoon, IL; Millstadt, IL…

National Provider Directory

National Provider Directory
Tax ID family
Southern Illinois Healthcare Foundation Inc38 organizations share this tax ID, including this one

Other organizations with this tax ID 37

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

View all 37

Locations

800 Range Ln
East Saint Louis, IL 62206
Phone (618) 337-3117

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1167091200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757548800000",
    "number": "1689739062",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8080 STATE ST",
            "city": "EAST SAINT LOUIS",
            "state": "IL",
            "postal_code": "622031808",
            "telephone_number": "618-397-3303",
            "fax_number": "618-397-7802"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 RANGE LN",
            "city": "CAHOKIA",
            "state": "IL",
            "postal_code": "622062022",
            "telephone_number": "618-337-3117",
            "fax_number": "618-337-3122"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN ILLINOIS HEALTHCARE FOUNDATION, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-26",
        "last_updated": "2025-09-11",
        "status": "A",
        "authorized_official_last_name": "MCCULLEY",
        "authorized_official_first_name": "LARRY",
        "authorized_official_title_or_position": "CHIEF OPERATING OFFICER",
        "authorized_official_telephone_number": "618-332-0783",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LS0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, School",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cahokia School Based Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Cahokia, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.