Active NPI
Matthew Sutherland
- Internal Medicine Physician
- Kankakee, IL
National Provider Identifier
1891310991
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 125.076651
- Practice address
- 350 N Wall St
Kankakee, IL 60901-2991 - Phone
- (815) 933-1671
- NPI assigned
- Jun 15, 2020
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 125.076651 | IL | Primary |
Addresses
Primary practice location
350 N Wall St
Kankakee, IL 60901-2991
Mailing address
350 N Wall St
Kankakee, IL 60901-2991
Phone (815) 933-1671
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Care Compare profile
Medicare Care Compare- Specialty
- Gastroenterology
- Education
- At Still University of Health Sciences, College of Osteo Med, Kirksville, 2020
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
1615 N Convent St
Suite 1
Bourbonnais, IL 60914-1081
Hospital & facility affiliations
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 125.076651 | IL | MD | Internal Medicine Physician |
Hospital & facility affiliations 1
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Kankakee, IL
- NPI 1467290809
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1592179200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1592179200000",
"number": "1891310991",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "350 N WALL ST",
"city": "KANKAKEE",
"state": "IL",
"postal_code": "609012991",
"telephone_number": "815-933-1671"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "350 N WALL ST",
"city": "KANKAKEE",
"state": "IL",
"postal_code": "609012991",
"telephone_number": "815-933-1671"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SUTHERLAND",
"first_name": "MATTHEW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-06-15",
"last_updated": "2020-06-15",
"certification_date": "2020-06-15",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "IL",
"license": "125.076651",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kankakee, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 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.