Theodore Rexford Addai, M.D.
Individual provider Active NPI Cardiovascular Disease Physician · Decatur, IL
NPI 1912985185 · NPPES record last updated Dec 20, 2021
Key facts
- NPI
- 1912985185
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Cardiovascular Disease Physician 207RC0000X
- License
- 036078026 (IL)
- Practice address
- 1770 E Lake Shore Dr Ste 105
Decatur, IL 62521-3800 - Phone
- (217) 422-6100
- Fax
- (833) 784-5326
- NPI assigned
- Jan 6, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 8
Hospital & facility affiliations 5
Medicare Care Compare profile
- Specialty
- Cardiovascular Disease (Cardiology)
- Education
- Other, 1985
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Prairie Cardiovascular Consultants LTD
St Marys Hospital Decatur of the Hospital Sisters of the Third Order
Practice addresses (Care Compare)
1 Saint Elizabeth Blvd
O Fallon, IL 62269-1099
Phone (618) 234-2120
1800 E Lake Shore Dr
Decatur, IL 62521-3810
Phone (217) 464-2966
1800 E Lake Shore Dr 6TH FLR
Decatur, IL 62521-3810
Phone (217) 422-6100
200 S Cedar St
Shelby Memorial
Shelbyville, IL 62565-1838
Phone (217) 774-3961
3 Saint Elizabeth Blvd
Suite 2800
O Fallon, IL 62269-1099
Phone (618) 233-6044
619 E Mason St
Springfield, IL 62701-1034
Phone (217) 788-0706
Hospital & facility affiliations
- St Marys Hospital
- St Johns Hospital
- HSHS Good Shepherd Hospital Inc
- Decatur Memorial Hospital
- Sarah Bush Lincoln Health Center
Merit-based Incentive Payment System (MIPS)
- Final score
- 94.81 of 100
- Quality
- 85.98
- Promoting interoperability
- 100
- Improvement activities
- 40
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20060914000039 | IL | Practitioner - Cardiovascular Disease (Cardiology) |
7810991338 | Reassigns benefits to 4 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036078026 | IL | MD | Specialist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Prairie Cardiovascular Consultants LTD | Cardiovascular Disease | Current |
Accepting new patients |
| St Marys Hospital Decatur of the Hospital Sisters of the Third Order | Current |
Accepting new patients | |
| Sarah Bush Lincoln Health Center | Current |
Accepting new patients | |
| Sarah Bush Lincoln Health Center | Current | Accepting new patients | |
| HSHS Medical Group Inc | Past | Accepting new patients |
Locations
409 W Oak St
Carbondale, IL 62901
Phone (618) 536-2565
2965 N Main St
Ste E
Decatur, IL 62526
Phone (217) 422-6100
1800 E Lake Shore Dr
Decatur, IL 62521
Phone (217) 464-2729
1770 E Lake Shore Dr
Ste 105
Decatur, IL 62521
Phone (217) 329-1000
503 N Maple St
Effingham, IL 62401
Phone (217) 342-2121
101 Professional Plz
Mattoon, IL 61938
Phone (217) 238-3730
1000 Health Center Dr
Mattoon, IL 61938
Phone (217) 258-2389
3 Saint Elizabeth Blvd
Ste 2800
O Fallon, IL 62269
Phone (618) 233-6044
619 E Mason St
Ste 4P57
Springfield, IL 62701
3051 Hollis Dr
Springfield, IL 62704
Phone (217) 523-5406
619 E Mason St
Ste 4
Springfield, IL 62701
619 E Mason St
#4P57
Springfield, IL 62701
Interoperability endpoints
- taddai99766@ewd.direct.hshs.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 036078026 | IL | |
| Cardiovascular Disease Physician | 207RC0000X | 036078026 | IL | Yes |
Addresses
Primary practice location
1770 E Lake Shore Dr Ste 105
Decatur, IL 62521-3800
Mailing address
1770 E Lake Shore Dr Ste 105
Decatur, IL 62521-3800
Phone (217) 422-6100
Other practice location 1
2965 N Main St Ste E
Decatur, IL 62526-4392
Phone (217) 422-6100
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000334245 | Other | IL | RAILROAD |
| 036078026 | Medicaid | IL |
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | taddai99766@ewd.direct.hshs.org | Direct |
Other providers in Decatur, IL
- Scott Abner
- Accelerated Rehabilitation Centers, LTD
- Joseph M Acchiardo
- Dawn Lee Ackerman
- Arion Beyonce Adams
- Addus Healthcare, Inc.
- Samaj Adhikari
- Coley Anne Adloff
- Advance Vision Eye Care, S.C.
- Aef Management Group
All providers in Decatur, IL · Cardiovascular Disease Physician in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 20, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.