Southern Illinois Gastroenterology LLC

Primary specialty

Gastroenterology PhysicianTaxonomy code 207RG0100X

Legal business name

SOUTHERN ILLINOIS GASTROENTEROLOGY LLC

Practice address

1212 Broadway
Highland, IL 62249-1960

Phone

(618) 391-5070

Fax

(618) 288-1872

NPI assigned

Jun 24, 2019

Last updated

Jun 24, 2019By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Edmundo A Rodriguez-Frias, MDNPI 1912117912

Title

Owner

Phone

(618) 391-5070

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Edmundo Alejandro Rodriguez-Frias, MD

  • Gastroenterology Physician
  • Maryville, IL
  • NPI 1912117912
  Authorized official Same address or phone

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

{
    "created_epoch": "1561334400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1561334400000",
    "number": "1902467798",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1212 BROADWAY",
            "city": "HIGHLAND",
            "state": "IL",
            "postal_code": "622491960",
            "telephone_number": "618-391-5070",
            "fax_number": "618-288-1872"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1212 BROADWAY",
            "city": "HIGHLAND",
            "state": "IL",
            "postal_code": "622491960",
            "telephone_number": "618-391-5070",
            "fax_number": "618-288-1872"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN ILLINOIS GASTROENTEROLOGY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-06-24",
        "last_updated": "2019-06-24",
        "status": "A",
        "authorized_official_last_name": "RODRIGUEZ-FRIAS",
        "authorized_official_first_name": "EDMUNDO",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "618-391-5070",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Gastroenterology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shivani Sharma, MD
• Chelsey Rachelle Short, M.S. CCC-SLP
• Emalee Shubert
• Donald E. Smith, CRNA
• Lauren Virginia Smith, PNP
• Southern Obstetric & Gyneco Associates (Southern OB/GYN-Highland)
• St Josephs Hospital Breese of the Hospital Sisters of the Third Orde (Madison County Rural Health)
• St Josephs Hospital of the Hospital Sisters of the Third Order of St F
• St Josephs Hospital of the Hospital Sisters of the Third Order of St F
• St Josephs Hospital of the Hospital Sisters of the Third Order of St F (HSHS St. Joseph's Hospital -Highland)

• Gastroenterology Physician in Highland, IL
• Providers in Highland, IL by specialty
• Gastroenterology Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.