NPIMap

Organization Active NPI

K M B S C

  • Anatomic Pathology & Clinical Pathology Physician
  • Decatur, IL
National Provider Identifier
1902867997
Registry record updated Jan 7, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
Legal business name
K M B S C
Practice address
1800 E Lake Shore Dr
Decatur, IL 62521-3883
Phone
(217) 464-2966
Fax
(217) 464-3193
NPI assigned
Mar 29, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 7, 2015

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

Authorized official

Name
Sue A Strayer, MDNPI 1376504365
Title
President
Phone
(217) 464-2966

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anatomic Pathology & Clinical Pathology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207ZP0102X Primary

Addresses

Primary practice location

1800 E Lake Shore Dr
Decatur, IL 62521-3883

Mailing address

PO Box 790129
St Louis, MO 63179-0129
Phone (217) 464-2966

Other identifiers 1

IdentifierTypeStateIssuer
0581522929OtherILBCBS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041116000043 IL Part B Supplier - Clinic/Group Practice 1951365303 Receives reassigned benefits from 3 practitioners
Practice locations: Gibson City, IL; Normal, IL; Clinton, IL

National Provider Directory

National Provider Directory

Locations

111 Spring St
Streator, IL 61364
Phone (815) 672-4587

Practitioners & affiliated clinicians

Practitioners 23

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

View all 23

NPI Registry JSON

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

{
    "created_epoch": "1143590400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1420588800000",
    "number": "1902867997",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 790129",
            "city": "ST LOUIS",
            "state": "MO",
            "postal_code": "631790129",
            "telephone_number": "217-464-2966",
            "fax_number": "217-464-3193"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1800 E LAKE SHORE DR",
            "city": "DECATUR",
            "state": "IL",
            "postal_code": "625213883",
            "telephone_number": "217-464-2966",
            "fax_number": "217-464-3193"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "K M B S C",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-29",
        "last_updated": "2015-01-07",
        "status": "A",
        "authorized_official_last_name": "STRAYER",
        "authorized_official_first_name": "SUE",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "217-464-2966",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "0581522929",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Decatur, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2015; 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.