Sara Kneedler Modert, D.O.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

036079217 Issued in IL

Practice address

1 Doctors Park Rd Ste C
Mount Vernon, IL 62864

Phone

(618) 244-1234

NPI assigned

Jan 19, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Family Practice

Education

Other, 1987

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Modert Family Practice LTDGroup PAC ID 3870669617, 2 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Sarah Bush Lincoln Health Center Hospital, Mattoon, IL, CCN 140189
• Good Samaritan Regional HLTH Center Hospital, Mount Vernon, IL, CCN 140046
• Deaconess Illinois Crossroads Hospital, Mount Vernon, IL, CCN 140294
• SSM Health St Mary'S Hospital -Centralia Hospital, Centralia, IL, CCN 140034

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

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.

• Modert Family Practice, LTD.

  • Family Medicine Physician
  • Mount Vernon, IL
  • NPI 1255311700
  Medicare reassignment Care Compare group NPD Authorized official

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Deaconess Illinois Crossroads Inc

  • General Acute Care Hospital
  • Mount Vernon, IL
  • NPI 1124745807
  Care Compare affiliation
• Good Samaritan Regional Health Center

  • General Acute Care Hospital
  • Mount Vernon, IL
  • NPI 1609897339
  Care Compare affiliation
• Sarah Bush Lincoln Health Center

  • General Acute Care Hospital
  • Mattoon, IL
  • NPI 1669564662
  Care Compare affiliation
• St Mary'S Hospital, Centralia, Illinois

  • General Acute Care Hospital
  • Centralia, IL
  • NPI 1083617245
  Care Compare affiliation

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

{
    "created_epoch": "1137628800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1604448000000",
    "number": "1700866258",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 802",
            "city": "MOUNT VERNON",
            "state": "IL",
            "postal_code": "628640017",
            "telephone_number": "618-244-1234"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 DOCTORS PARK RD STE C",
            "city": "MOUNT VERNON",
            "state": "IL",
            "postal_code": "62864",
            "telephone_number": "618-244-1234"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MODERT",
        "first_name": "SARA",
        "middle_name": "KNEEDLER",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-01-19",
        "last_updated": "2020-11-04",
        "certification_date": "2020-11-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036079217",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036079217",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Raquel A Minor
• Miracle-Ear, Inc.
• Dennis Paul Mlot, M.D.
• Modert Family Practice, LTD.
• Christopher Wilson Modert, D.O.
• Ahmed Salem Mohamed, MD
• Mohammed Al-Zoubaidi MD PLLC
• Shaji A Mohammed
• Robert Mooney, LCPC
• Judith C Morgan, RN/BA/CADC

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.