NPIMap

Individual provider Active NPI

Suresh Krishnamoorthy, M.D.

  • Geriatric Medicine (Internal Medicine) Physician
  • Centralia, IL
National Provider Identifier
1760440580
Registry record updated Jul 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Medicine (Internal Medicine) PhysicianTaxonomy code 207RG0300X
License
036091773 Issued in IL
Practice address
1054 M L King Dr
Suite 126
Centralia, IL 62801-3000
Phone
(618) 533-5500
Fax
(618) 533-5501
NPI assigned
May 2, 2006
Last updated
Jul 13, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Geriatric Medicine (Internal Medicine) Physician 207RG0300X 036091773 IL Primary

Addresses

Primary practice location

1054 M L King Dr
Suite 126
Centralia, IL 62801-3000

Mailing address

1054 M L King Dr
Suite 126
Centralia, IL 62801-3000
Phone (618) 533-5500

Other identifiers 1

IdentifierTypeStateIssuer
036-091773MedicaidIL

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
I20040915000491 IL Practitioner - Internal MedicinePractitioner - Geriatric Medicine 5496722050 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Geriatric Medicine
Education
Other, 1982
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

1054 Martin Luther King Dr
Suite 126
Centralia, IL 62801-3065
Phone (618) 533-5500

400 N Pleasant Ave
Centralia, IL 62801-3056
Phone (618) 436-8000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as individual

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Quality
92.55
Promoting interoperability
100
Improvement activities
40
Cost
79.49

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
St. Mary's Hospital, Centralia, Illinois CurrentSince Jan 24, 2000 Accepting new patients
St. Mary's Hospital, Centralia, Illinois CurrentSince Jan 24, 2000 Accepting new patients
St. Mary's Hospital, Centralia, Illinois Current Accepting new patients
Suresh Krishnamoorthy MD SC Geriatric Medicine CurrentSince Aug 1, 2004 Accepting new patients

Locations

1054 Martin Luther King Dr
Centralia, IL 62801
Phone (618) 244-0031

1054 Martin Luther King Dr
Ste 126
Centralia, IL 62801
Phone (618) 532-1911

400 N Pleasant Ave
Centralia, IL 62801
Phone (618) 436-5221

7420 Solutions Ctr
Chicago, IL 60677
Phone (314) 989-3155

1250 W Whittaker St
Salem, IL 62881
Phone (618) 548-3740

Organizations & group practices 4

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.

Hospital & facility affiliations 11

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

NPI Registry JSON

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

{
    "created_epoch": "1146528000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1760440580",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1054 M L KING DR",
            "address_2": "SUITE 126",
            "city": "CENTRALIA",
            "state": "IL",
            "postal_code": "628013000",
            "telephone_number": "618-533-5500",
            "fax_number": "618-533-5501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1054 M L KING DR",
            "address_2": "SUITE 126",
            "city": "CENTRALIA",
            "state": "IL",
            "postal_code": "628013000",
            "telephone_number": "618-533-5500",
            "fax_number": "618-533-5501"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KRISHNAMOORTHY",
        "first_name": "SURESH",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-02",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "IL",
            "license": "036091773",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036-091773",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Centralia, IL

Sources for this page

Verify at the official NPI Registry.