Edem S Agamah, MD
Individual provider Active NPI Hematology & Oncology Physician · Springfield, IL
NPI 1932147279 · NPPES record last updated Oct 16, 2020
Key facts
- NPI
- 1932147279
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Hematology & Oncology Physician 207RH0003X
- License
- 036085000 (IL)
- Practice address
- 315 W Carpenter St
1St Floor, Clinic B
Springfield, IL 62702-4901 - Phone
- (217) 545-8000
- Fax
- (217) 545-1141
- NPI assigned
- Jun 2, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 5
Hospital & facility affiliations 6
Medicare Care Compare profile
- Specialty
- Hematology/Oncology
- Education
- Other, 1985
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Siu Physicians and Surgeons Inc
Practice addresses (Care Compare)
315 W Carpenter St
Springfield, IL 62702-4901
Phone (217) 545-8000
Hospital & facility affiliations
- Memorial Medical Center
- St Johns Hospital
- Jacksonville Memorial Hospital
- Hillsboro Area Hospital
- Carlinville Area Hospital
Merit-based Incentive Payment System (MIPS)
- Final score
- 75 of 100
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 |
|---|---|---|---|---|
| I20070915000133 | IL | Practitioner - Hematology/Oncology | 3173533791 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036085000 | IL | MD | Hematology & Oncology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Siu Physicians & Surgeons, Inc | Current |
Accepting new patients | |
| Board of Trustees of Southern Illinois University | Current | Accepting new patients | |
| Siu Physicians & Surgeons, Inc | Current |
Accepting new patients | |
| Siu Physicians & Surgeons, Inc | Past | Accepting new patients | |
| Passavant Memorial Area Hospital Association | Past | Accepting new patients |
Locations
1600 W Walnut St
South Jacksonville, IL 62650
Phone (217) 245-7275
319 E Madison St
Ste F
Springfield, IL 62701
Phone (217) 525-2500
747 N Rutledge St
#2204
Springfield, IL 62702
Phone (217) 525-2500
751 N Rutledge St
Springfield, IL 62702
Phone (217) 545-0182
315 W Carpenter St
Springfield, IL 62702
Phone (217) 545-5817
315 W Carpenter St
Fl 1
Springfield, IL 62702
Interoperability endpoints
- edemagamah@siusm.allscriptsdirect.net
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Hematology & Oncology Physician | 207RH0003X | 036085000 | IL | Yes |
Addresses
Primary practice location
315 W Carpenter St
1St Floor, Clinic B
Springfield, IL 62702-4901
Mailing address
315 W Carpenter St
PO Box 19678
Springfield, IL 62702-4901
Phone (217) 545-8000
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 272742 | Other | IL | HEALTHLINK |
| 8415062 | Other | IL | BLUE CROSS BLUE SHIELD |
| 036085000 | Medicaid | IL | |
| 900001174 | Other | IL | RAILROAD MEDICARE |
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | edemagamah@siusm.allscriptsdirect.net |
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 16, 2020. 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.