NPIMap

Individual provider Active NPI

Edgardo S Emilia, MD

  • Internal Medicine Physician
  • Mount Vernon, IL
National Provider Identifier
1710950217
Registry record updated Jul 14, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
036095710 Issued in IL
Practice address
1009 S 42ND St
Suite 1
Mount Vernon, IL 62864-6218
Phone
(618) 241-6015
NPI assigned
Feb 7, 2006
Last updated
Jul 14, 2020By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 14, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 036-095710 IL
Internal Medicine Physician 207R00000X 036095710 IL Primary

Addresses

Primary practice location

1009 S 42ND St
Suite 1
Mount Vernon, IL 62864-6218

Mailing address

1009 S 42ND St
Suite 1
Mount Vernon, IL 62864-6218
Phone (618) 241-6015

Other identifiers 1

IdentifierTypeStateIssuer
036095710MedicaidIL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060117000526 IL Practitioner - Internal MedicinePractitioner - Nephrology 9638068901 Practice locations: Mount Vernon, IL

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
036-095710ILMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Marshall Browning Hospital Association CurrentSince Mar 12, 2022 Accepting new patients
Marshall Browning Hospital Association CurrentSince Mar 12, 2022 Accepting new patients
California Em-I Medical Services, a Medical Corporation Emergency Medicine Past Accepting new patients
Rend Emergency Physicians Emergency Medicine Past Accepting new patients
Clovis Urgent Care Medical Center Past Accepting new patients
E & M Multispecialty Inc Internal Medicine Past Accepting new patients
Emergency Medical Services Group Emergency Medicine Past Accepting new patients
Team Physicians of California Medical Group Inc Emergency Medicine Past Accepting new patients
Quantum Healthcare Medical Associates Inc. Internal Medicine PastSince Jun 1, 2009 Accepting new patients
Jse Emergency Medical Group Emergency Medicine Past Accepting new patients

Locations

900 N Washington St
Du Quoin, IL 62832
Phone (618) 542-1050

Organizations & group practices 10

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1139270400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1594684800000",
    "number": "1710950217",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1009 S 42ND ST",
            "address_2": "SUITE 1",
            "city": "MOUNT VERNON",
            "state": "IL",
            "postal_code": "628646218",
            "telephone_number": "618-241-6015"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1009 S 42ND ST",
            "address_2": "SUITE 1",
            "city": "MOUNT VERNON",
            "state": "IL",
            "postal_code": "628646218",
            "telephone_number": "618-241-6015"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EMILIA",
        "first_name": "EDGARDO",
        "middle_name": "S",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-02-07",
        "last_updated": "2020-07-14",
        "certification_date": "2020-07-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "IL",
            "license": "036-095710",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036095710",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036095710",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mount Vernon, IL

Sources for this page

Verify at the official NPI Registry.