Surgical Specialists of Central Illinois SC

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

Legal business name

SURGICAL SPECIALISTS OF CENTRAL ILLINOIS SC

Practice address

1750 E Lake Shore Dr
Ste 200
Decatur, IL 62521-3809

Phone

(217) 428-6300

Fax

(217) 428-6322

NPI assigned

Nov 17, 2005

Organization subpart

No

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

Authorized official

Name

John Joseph White, MD

Title

President

Phone

(217) 428-6300

Specialties & licenses 2

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1132185600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1195776000000",
    "number": "1760464481",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1750 E LAKE SHORE DR",
            "address_2": "STE 200",
            "city": "DECATUR",
            "state": "IL",
            "postal_code": "625213809",
            "telephone_number": "217-428-6300",
            "fax_number": "217-428-6322"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1750 E LAKE SHORE DR",
            "address_2": "STE 200",
            "city": "DECATUR",
            "state": "IL",
            "postal_code": "625213809",
            "telephone_number": "217-428-6300",
            "fax_number": "217-428-6322"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SURGICAL SPECIALISTS OF CENTRAL ILLINOIS SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-17",
        "last_updated": "2007-11-23",
        "status": "A",
        "authorized_official_last_name": "WHITE",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "JOSEPH",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "217-428-6300",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": "IL",
            "license": null,
            "primary": true
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery, Vascular Surgery",
            "state": "IL",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE TRAVELERS",
            "identifier": "CI8411",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Randy K Sulaver II, M.D.
• Jessica Sullivan, CCC-SLP
• Yifei Sun, M.D.
• Jennifer R Sunderland, PA-C
• Sujiththa Suntharalingam, M.D.
• Ashley Swallow, LCSW
• Autumn Swansen
• Michael Swengel
• Sarah Ann Sydor, ATC/L
• Quinlan Syfert, PT

• Surgery Physician in Decatur, IL
• Providers in Decatur, IL by specialty
• Surgery Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 2007; 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.