Southern Illinois Neuropsychology LLC

Primary specialty

Clinical NeuropsychologistTaxonomy code 103G00000X

License

071009269 Issued in IL

Legal business name

SOUTHERN ILLINOIS NEUROPSYCHOLOGY LLC

Practice address

60 S State Route 157
Edwardsville, IL 62025

Phone

(618) 391-4021

NPI assigned

Jan 3, 2018

Organization subpart

No

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

Authorized official

Name

Dr. Phillip Ruppert, PHDNPI 1861771206

Title

Owner

Phone

(618) 391-4021

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Locations

Practitioners 1

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

• Phillip D. Ruppert, PH.D.

  • Clinical Neuropsychologist
  • Saint Louis, MO
  • NPI 1861771206

  IL

  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1514937600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1644451200000",
    "number": "1861909509",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 OAK DR UNIT 352",
            "city": "MARYVILLE",
            "state": "IL",
            "postal_code": "620627026",
            "telephone_number": "618-391-4021"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "60 S STATE ROUTE 157",
            "city": "EDWARDSVILLE",
            "state": "IL",
            "postal_code": "62025",
            "telephone_number": "618-391-4021"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN ILLINOIS NEUROPSYCHOLOGY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-01-03",
        "last_updated": "2022-02-10",
        "certification_date": "2022-02-10",
        "status": "A",
        "authorized_official_last_name": "RUPPERT",
        "authorized_official_first_name": "PHILLIP",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "618-391-4021",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Clinical Neuropsychologist",
            "state": "IL",
            "license": "071009269",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jason Smith, NP
• Vanessa Smith
• Clayton Allen Snyders, RN
• Ellen Snyders
• Soulful Spaces Therapy PLLC
• Southern Illinois Pediatric Dentistry of Edwardsville
• Nancy C Spina
• Sportchiro, LLC
• Lynette Kathleen Sproull, CCC-SLP
• Melanie Spung

• Clinical Neuropsychologist in Edwardsville, IL
• Providers in Edwardsville, IL by specialty
• Clinical Neuropsychologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2022; 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.