Suresh Krishnamoorthy MD SC

Primary specialty

Geriatric Medicine (Internal Medicine) PhysicianTaxonomy code 207RG0300X

Legal business name

SURESH KRISHNAMOORTHY MD SC

Practice address

1054 M L King Dr
Suite 126
Centralia, IL 62801-3000

Phone

(618) 533-5500

Fax

(618) 533-5501

NPI assigned

Jun 12, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Suresh Krishnamoorthy, MDNPI 1760440580

Title

Physician

Phone

(618) 533-5500

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.

• Suresh Krishnamoorthy, M.D.

  • Geriatric Medicine (Internal Medicine) Physician
  • Centralia, IL
  • NPI 1760440580
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1181606400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1912101163",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1054 M L KING DR",
            "address_2": "SUITE 126",
            "city": "CENTRALIA",
            "state": "IL",
            "postal_code": "628013000",
            "telephone_number": "618-533-5500",
            "fax_number": "618-533-5501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1054 M L KING DR",
            "address_2": "SUITE 126",
            "city": "CENTRALIA",
            "state": "IL",
            "postal_code": "628013000",
            "telephone_number": "618-533-5500",
            "fax_number": "618-533-5501"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SURESH KRISHNAMOORTHY MD SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-12",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "KRISHNAMOORTHY",
        "authorized_official_first_name": "SURESH",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "618-533-5500",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RG0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Linda S Stover, MSED LCPC
• Bradley C Stufflebam, M.D.
• Wendy Suey
• Erica L Summers
• George Sun, MD
• Scott Allen Tate, PT
• Michael Taylor, LPHA, LCPC, CRC
• Terry Chiropractic Clinic, LTD
• Mark W Terry, DC
• Anisha Thole

• Geriatric Medicine (Internal Medicine) Physician in Centralia, IL
• Providers in Centralia, IL by specialty
• Geriatric Medicine (Internal Medicine) Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.