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

2001 State St
East Saint Louis, IL 62205-1803

Phone

(618) 271-9191

Fax

(618) 271-9617

NPI assigned

Jan 2, 2007

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

Chief Operating Officer

Phone

(618) 332-0783

Specialties & licenses 5

Addresses

Other names 1

• State Street Center Doing business as

Medicare fee-for-service enrollment

Enrolled in IL2 enrollments

Enrollment records 2

Federally qualified health center certification: CCN 141843

Legal name

SOUTHERN ILLINOIS HEALTHCARE FOUNDATION INC

Doing business as

SIHF HEALTHCARE

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

Oct 1, 1991

Last certification

Oct 1, 1991

Ownership / control type

For profit – partnership

Organization structure

CorporationNon-profit

Incorporated

Sep 27, 1985 in IL

Enrollment address

2001 State St
East Saint Louis, IL 62205-1803

All disclosed owners & managing parties 11

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

Practitioners 8

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

• Rashid Ahmed Dalal, MD

  • Nephrology Physician
  • Fairview Heights, IL
  • NPI 1265434815
  NPD
• Dolores J Gunn, M.D.

  • Emergency Medicine Physician
  • East Saint Louis, IL
  • NPI 1740247360

  Family Medicine

  NPD
• Hatim A Mahmood, M.D.

  • Cardiovascular Disease Physician
  • Belleville, IL
  • NPI 1174556583
  NPD
• Jordan Kenneth Marshall, MD

  • Emergency Medicine Physician
  • East Saint Louis, IL
  • NPI 1396188025
  NPD
• Natalie D Menossi, PA

  • Physician Assistant
  • Glen Carbon, IL
  • NPI 1912195447
  NPD
• Kelechi J.N. Loynd, MD

  • Psychiatry Physician
  • Saint Louis, MO
  • NPI 1720104888
  NPD
• Safiya D McNeese, M.D.

  • Family Medicine Physician
  • Kansas City, MO
  • NPI 1962818823
  NPD
• Alissa Leigh Struble, FNP

  • Nurse Practitioner
  • Florissant, MO
  • NPI 1164105490
  NPD

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

{
    "created_epoch": "1167696000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1225324800000",
    "number": "1811054935",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8080 STATE ST",
            "city": "EAST SAINT LOUIS",
            "state": "IL",
            "postal_code": "622031808",
            "telephone_number": "618-397-3303",
            "fax_number": "618-397-7802"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2001 STATE ST",
            "city": "EAST SAINT LOUIS",
            "state": "IL",
            "postal_code": "622051803",
            "telephone_number": "618-271-9191",
            "fax_number": "618-271-9617"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN ILLINOIS HEALTHCARE FOUNDATION, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-02",
        "last_updated": "2008-10-30",
        "status": "A",
        "authorized_official_last_name": "MCCULLEY",
        "authorized_official_first_name": "LARRY",
        "authorized_official_title_or_position": "CHIEF OPERATING OFFICER",
        "authorized_official_telephone_number": "618-332-0783",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "State Street Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Southern Illinois Healthcare Foundation, Inc.
• Southern Illinois Healthcare Foundation, Inc.
• Southern Illinois Healthcare Foundation, Inc.
• Southern Illinois Healthcare Foundation, Inc.
• Southern Illinois Healthcare Foundation, Inc.
• Southern Illinois Healthcare Foundation, Inc.
• Southern Illinois Regional Wellness Center
• Southern Illinois University Edwardsville
• Sse Care LLC
• Latisha Trenice Stennis, PMHNP

• Federally Qualified Health Center (FQHC) in East Saint Louis, IL
• Providers in East Saint Louis, 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 Oct 30, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.