NPIMap

Individual provider Active NPI

Salim Shackour, MD

  • Internal Medicine Physician
  • Decatur, IL
National Provider Identifier
1760673099
Registry record updated Jan 5, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
036119015 Issued in IL
Practice address
1800 E Lake Shore Dr
Decatur, IL 62521-3810
Phone
(217) 464-5811
Fax
(217) 464-1318
NPI assigned
Aug 1, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 5, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 036119015 IL Primary

Addresses

Primary practice location

1800 E Lake Shore Dr
Decatur, IL 62521-3810

Mailing address

1050 W 10TH St
Attn: Executive Director of Physician Clinics
Rolla, MO 65401-2905
Phone (573) 364-9000

Other practice location 1

1050 W 10th St
Rolla, MO 65401
Phone (573) 364-9000

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address sshackour248568@ewd.direct.hshs.org Direct

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
I20190611001631 IL Practitioner - Hospitalist 3870661358 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Hospitalist
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

1 Saint Anthonys Way
Alton, IL 62002-4568
Phone (618) 465-2571

1 Saint Elizabeth Blvd
O Fallon, IL 62269-1099
Phone (618) 234-2120

1800 E Lake Shore Dr
Decatur, IL 62521-3810
Phone (217) 464-2966

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Quality
96.63
Improvement activities
40
Cost
81.81

Merit-based Incentive Payment System (MIPS)

Final score
94.81 of 100Reported as apm
Quality
85.98
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Ameripath Indianapolis PC Current Accepting new patients
HSHS Medical Group Inc Current Accepting new patients
Cep America-Illinois Hospitalists, LLP Internal Medicine Current Accepting new patients
Cep America-Illinois Hospitalists CurrentSince Feb 16, 2024 Accepting new patients
Cep America-Illinois Hospitalists, LLP Internal Medicine CurrentSince Feb 16, 2024 Accepting new patients
HSHS Medical Group Inc CurrentSince Jul 1, 2019 Accepting new patients
HSHS Medical Group Inc Internal Medicine CurrentSince Jul 1, 2019 Accepting new patients
Ozarks Medical Center Past Accepting new patients

Locations

1601 Cummins Dr
Ste D
Modesto, CA 95358
Phone (510) 851-7423

1900 E Lake Shore Dr
Ste 330
Decatur, IL 62521
Phone (217) 423-2889

1800 E Lake Shore Dr
Decatur, IL 62521
Phone (217) 464-2729

1 Saint Elizabeth Blvd
O Fallon, IL 62269
Phone 618234212012438

800 E Carpenter St
Springfield, IL 62769
Phone (217) 525-5643

4500 Memorial Dr
Swansea, IL 62226
Phone (618) 233-7750

1000 W 10th St
Rolla, MO 65401
Phone (573) 364-9000

Interoperability endpoints

  • Direct secure messaging: sshackour248568@ewd.direct.hshs.org

Organizations & group practices 8

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.

Hospital & facility affiliations 6

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": "1185926400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1641340800000",
    "number": "1760673099",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1050 W 10TH ST",
            "address_2": "ATTN: EXECUTIVE DIRECTOR OF PHYSICIAN CLINICS",
            "city": "ROLLA",
            "state": "MO",
            "postal_code": "654012905",
            "telephone_number": "573-364-9000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1800 E LAKE SHORE DR",
            "city": "DECATUR",
            "state": "IL",
            "postal_code": "625213810",
            "telephone_number": "217-464-5811",
            "fax_number": "217-464-1318"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1050 W 10th St",
            "address_purpose": "LOCATION",
            "city": "Rolla",
            "state": "MO",
            "postal_code": "65401",
            "country_code": "US",
            "telephone_number": "573-364-9000",
            "fax_number": "573-426-3552",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHACKOUR",
        "first_name": "SALIM",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-08-01",
        "last_updated": "2022-01-05",
        "certification_date": "2022-01-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036119015",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "sshackour248568@ewd.direct.hshs.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/CCD/TXT",
            "address_1": "1800 E Lake Shore Dr",
            "city": "Decatur",
            "state": "IL",
            "country_code": "US",
            "postal_code": "625213810",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Decatur, IL

Sources for this page

Verify at the official NPI Registry.