Active NPI
Kathy D. Swafford, M.D.
- Pediatrics Physician
- Carbondale, IL
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 036074783
- Practice address
- 300 W Oak St
Carbondale, IL 62901-1400 - Phone
- (618) 536-6621
- NPI assigned
- Oct 21, 2005
- Last updated
- Jun 13, 2024
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 036074783 | IL | Primary |
| Child Abuse Pediatrics Physician | 2080C0008X | 036074783 | IL |
Addresses
Primary practice location
300 W Oak St
Carbondale, IL 62901-1400
Mailing address
201 E Madison St Ste 328
Springfield, IL 62702-5131
Phone (217) 545-8000
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 102371 | Other | IL | HEALTHLINK |
| 021175 | Other | IL | HEALTH ALLIANCE |
| 09122971 | Other | IL | BLUE CROSS/BLUE SHIELD |
| 036074783 | Medicaid | IL |
Medicare participation
Medicare enrollment files- 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
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036074783 | IL | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Siu Physicians & Surgeons, Inc | Current | Accepting new patients | |
| Board of Trustees of Southern Illinois University | Current | Accepting new patients | |
| Board of Trustees of Southern Illinois University | Current | Accepting new patients | |
| Siu Physicians & Surgeons, Inc | Current | Accepting new patients | |
| Board of Trustees of Southern Illinois University | Current | Accepting new patients | |
| Southern Illinois University | Past | Accepting new patients |
Locations
201 E Madison St
Ste 328
Springfield, IL 62702
520 N 4th St
Springfield, IL 62702
Phone (217) 757-8100
751 N Rutledge St
Springfield, IL 62702
Phone (217) 545-0182
Interoperability endpoints
- kathyswafford@siusm.allscriptsdirect.net
Organizations & group practices 6
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.
-
dba Siu Center for Family Medicine
- Primary Care Clinic/Center
- Springfield, IL
- NPI 1396097960
-
dba SIU HealthCare
- Endocrinology, Diabetes & Metabolism Physician
- Springfield, IL
- NPI 1558385989
-
dba Carbondale Care A Van
- Rural Health Clinic/Center
- Carbondale, IL
- NPI 1215978127
-
dba SIU Center for Family Medicine - Care-A-Van
- Federally Qualified Health Center (FQHC)
- Carbondale, IL
- NPI 1568210425
-
- Durable Medical Equipment & Medical Supplies
- Springfield, IL
- NPI 1164055976
-
dba Community Nursing Services
- Clinic/Center
- E Saint Louis, IL
- NPI 1306273776
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1129852800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1718236800000",
"number": "1871583849",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "201 E MADISON ST STE 328",
"city": "SPRINGFIELD",
"state": "IL",
"postal_code": "627025131",
"telephone_number": "217-545-8000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "300 W OAK ST",
"city": "CARBONDALE",
"state": "IL",
"postal_code": "629011400",
"telephone_number": "618-536-6621"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SWAFFORD",
"first_name": "KATHY",
"middle_name": "D.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2005-10-21",
"last_updated": "2024-06-13",
"certification_date": "2024-06-13",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "IL",
"license": "036074783",
"primary": true
},
{
"code": "2080C0008X",
"taxonomy_group": "",
"desc": "Pediatrics, Child Abuse Pediatrics",
"state": "IL",
"license": "036074783",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTHLINK",
"identifier": "102371",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTH ALLIANCE",
"identifier": "021175",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS/BLUE SHIELD",
"identifier": "09122971",
"state": "IL"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "036074783",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Carbondale, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2024; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.