Southern Illinois Healthcare Foundation, Inc.

Primary specialty

Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X

Legal business name

SOUTHERN ILLINOIS HEALTHCARE FOUNDATION, INC.

Practice address

3214 N Illinois St
Swansea, IL 62226-2330

Phone

(618) 233-0742

NPI assigned

May 11, 2017

Organization subpart

No

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

Authorized official

Name

Mr. Larry McCulley

Title

Ceo

Phone

(618) 332-0694

Specialties & licenses 5

Addresses

Other names 1

• Swansea Health Center Other name

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Locations

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jenna Marie Churnock, DNP, FNP-C

  • Family Nurse Practitioner
  • Belleville, IL
  • NPI 1285917492
  NPD
• Christal Gabrielson

  • Mental Health Counselor
  • Alton, IL
  • NPI 1053714329
  NPD
• Miguel H. Granger, MD

  • Family Medicine Physician
  • East Saint Louis, IL
  • NPI 1265527998
  NPD
• Kayla Ann Pryor, APRN

  • Family Nurse Practitioner
  • East Saint Louis, IL
  • NPI 1093345415
  NPD
• Jordan Kristopher Romick, DO

  • Sports Medicine (Family Medicine) Physician
  • Fremont, OH
  • NPI 1093219404
  NPD

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

{
    "created_epoch": "1494460800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1494460800000",
    "number": "1801322730",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2041 GOOSE LAKE RD",
            "city": "SAUGET",
            "state": "IL",
            "postal_code": "622062822",
            "telephone_number": "618-332-0953"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3214 N ILLINOIS ST",
            "city": "SWANSEA",
            "state": "IL",
            "postal_code": "622262330",
            "telephone_number": "618-233-0742"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN ILLINOIS HEALTHCARE FOUNDATION, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-05-11",
        "last_updated": "2017-05-11",
        "status": "A",
        "authorized_official_last_name": "MCCULLEY",
        "authorized_official_first_name": "LARRY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "618-332-0694",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": "IL",
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "IL",
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": "IL",
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Swansea Health Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Jacqueline Smith
• Rosalyn I Smith, D.D.S.
• Kristin Nicole Solovitz, MSPT
• Southern Illinois Caring Hands
• Southern Illinois Healthcare Foundation, Inc.
• Southwest Illinois Health Services, LLP
• Southwest Illinois Health Services, LLP
• Southwestern Illinois Visiting Nurse Association
• Specialists in OB GYN, LTD.
• Ruth E Sponsler, MSED, MA, LCPC

• Federally Qualified Health Center (FQHC) in Swansea, IL
• Providers in Swansea, IL by specialty
• Federally Qualified Health Center (FQHC) in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.