Socorro J Shelton, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

036-124717 Issued in IL

Practice address

305 W Jackson St
Ste 200
Carbondale, IL 62901-1474

Phone

(618) 453-7777

Fax

(618) 453-1102

NPI assigned

Jun 15, 2010

Last updated

Dec 28, 2020By the provider in NPPES

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

Other names 1

• Socorro J Justiniani Former name

Electronic endpoints 2

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, 2007

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Board of Trustees of Southern Illinois UniversityGroup PAC ID 4486667888, 139 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Memorial Hospital of Carbondale Hospital, Carbondale, IL, CCN 140164
• St Joseph Memorial Hospital Hospital, Murphysboro, IL, CCN 141334
• Herrin Hospital Hospital, Herrin, IL, CCN 140011

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: socorroshelton@siusm.allscriptsdirect.net
• Direct secure messaging: sshelton15461@sih.direct-ci.com

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.

• Board of Trustees of Southern Illinois University

  dba Siu Center for Family Medicine

  • Primary Care Clinic/Center
  • Springfield, IL
  • NPI 1396097960
  Medicare reassignment Care Compare group
• Board of Trustees of Southern Illinois University

  dba Carbondale Care A Van

  • Rural Health Clinic/Center
  • Carbondale, IL
  • NPI 1215978127
  NPD

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

• Southern Illinois Hospital Services

  dba Memorial Hospital of Carbondale

  • General Acute Care Hospital
  • Carbondale, IL
  • NPI 1093801797
  Care Compare affiliation
• Southern Illinois Hospital Services

  dba St. Joseph Memorial Hospital

  • Critical Access Hospital
  • Murphysboro, IL
  • NPI 1356435135
  Care Compare affiliation
• Southern Illinois Hospital Services

  dba Herrin Hospital

  • General Acute Care Hospital
  • Herrin, IL
  • NPI 1528158573
  Care Compare affiliation

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

{
    "created_epoch": "1276560000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1609113600000",
    "number": "1780905638",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2553 KEN GRAY BLVD",
            "address_2": "STE 200",
            "city": "W FRANKFORT",
            "state": "IL",
            "postal_code": "628964174",
            "telephone_number": "618-932-3937"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "305 W JACKSON ST",
            "address_2": "STE 200",
            "city": "CARBONDALE",
            "state": "IL",
            "postal_code": "629011474",
            "telephone_number": "618-453-7777",
            "fax_number": "618-453-1102"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2553 Ken Gray Blvd",
            "address_purpose": "LOCATION",
            "city": "West Frankfort",
            "state": "IL",
            "postal_code": "628964174",
            "country_code": "US",
            "telephone_number": "618-932-3937",
            "fax_number": "618-932-2734",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHELTON",
        "first_name": "SOCORRO",
        "middle_name": "J",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-06-15",
        "last_updated": "2020-12-28",
        "certification_date": "2020-12-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036-124717",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036124717",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "socorroshelton@siusm.allscriptsdirect.net",
            "affiliation": "N",
            "address_1": "305 W Jackson St",
            "address_2": "STE 200",
            "city": "Carbondale",
            "state": "IL",
            "country_code": "US",
            "postal_code": "629011474",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "sshelton15461@sih.direct-ci.com",
            "affiliation": "N",
            "address_1": "2553 Ken Gray Blvd",
            "city": "West Frankfort",
            "state": "IL",
            "country_code": "US",
            "postal_code": "628964174",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "SOCORRO",
            "last_name": "JUSTINIANI",
            "middle_name": "J",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Samantha Sheppard, LCSW, LICSW
• Keni Sherrell, LPN
• Daniel Sherwood, PA
• Roger Sebastian Shinnerl, M.D.
• Jennifer Marie Shopinski, APN, CNM, IBCLC

• Family Medicine Physician in Carbondale, IL
• Providers in Carbondale, 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 Dec 28, 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.