NPIMap

Organization Active NPI

Board of Trustees of Southern Illinois University

Doing business as Noll Medical Pavilion Clinic

  • Primary Care Clinic/Center
  • Springfield, IL
National Provider Identifier
1922350099
Registry record updated Mar 14, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
BOARD OF TRUSTEES OF SOUTHERN ILLINOIS UNIVERSITY
Doing business as
Noll Medical Pavilion Clinic
Practice address
5220 S 6TH Street Rd
Suite 1200
Springfield, IL 62703-5735
Phone
(217) 545-8000
Fax
(217) 747-1351
NPI assigned
Oct 12, 2012
Last updated
Mar 14, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 14, 2013

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

Authorized official

Name
Dr. Janet R Albers, MDNPI 1023006913
Title
Director
Phone
(217) 757-8100

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X Primary

Addresses

Primary practice location

5220 S 6TH Street Rd
Suite 1200
Springfield, IL 62703-5735

Mailing address

PO Box 19670
Springfield, IL 62794-9670
Phone (217) 545-8000

Other names 1

  • NOLL MEDICAL PAVILION CLINIC Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130424001019 IL Part B Supplier - Clinic/Group Practice 4486667888 Receives reassigned benefits from 288 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Taylorville, IL; Springfield, IL; Quincy, IL; Pittsfield, IL; Lincoln, IL; Jacksonville, IL; Decatur, IL; Carbondale, IL

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

612 N 11th St
Quincy, IL 62301
Phone (217) 224-9484

5220 6th Street Frontage Rd E
Ste 1200
Springfield, IL 62703
Phone (217) 545-6900

Practitioners & affiliated clinicians

Practitioners 59

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.

View all 59

NPI Registry JSON

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

{
    "created_epoch": "1350000000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1363219200000",
    "number": "1922350099",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 19670",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627949670",
            "telephone_number": "217-545-8000",
            "fax_number": "217-747-1351"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5220 S 6TH STREET RD",
            "address_2": "SUITE 1200",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627035735",
            "telephone_number": "217-545-8000",
            "fax_number": "217-747-1351"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOARD OF TRUSTEES OF SOUTHERN ILLINOIS UNIVERSITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-12",
        "last_updated": "2013-03-14",
        "status": "A",
        "authorized_official_last_name": "ALBERS",
        "authorized_official_first_name": "JANET",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "217-757-8100",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "NOLL MEDICAL PAVILION CLINIC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Springfield, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2013; 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.