NPIMap

Individual provider Active NPI

Edem S Agamah, MD

  • Hematology & Oncology Physician
  • Springfield, IL
National Provider Identifier
1932147279
Registry record updated Oct 16, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hematology & Oncology PhysicianTaxonomy code 207RH0003X
License
036085000 Issued in 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
Last updated
Oct 16, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 16, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Hematology & Oncology Physician 207RH0003X 036085000 IL Primary

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

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address edemagamah@siusm.allscriptsdirect.net

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070915000133 IL Practitioner - Hematology/Oncology 3173533791 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Hematology/Oncology
Education
Other, 1985
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Siu Physicians and Surgeons IncGroup PAC ID 2365352820, 316 clinicians

Practice addresses (Care Compare)

315 W Carpenter St
Springfield, IL 62702-4901
Phone (217) 545-8000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as group

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
036085000ILMDHematology & Oncology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Siu Physicians & Surgeons, Inc CurrentSince Sep 1, 2015 Accepting new patients
Board of Trustees of Southern Illinois University Current Accepting new patients
Siu Physicians & Surgeons, Inc CurrentSince Sep 1, 2015 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

315 W Carpenter St
Springfield, IL 62702
Phone (217) 545-5817

315 W Carpenter St
Fl 1
Springfield, IL 62702

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

Interoperability endpoints

  • Direct secure messaging: edemagamah@siusm.allscriptsdirect.net

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1149206400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1602806400000",
    "number": "1932147279",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "315 W CARPENTER ST",
            "address_2": "PO BOX 19678",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627024901",
            "telephone_number": "217-545-8000",
            "fax_number": "217-545-1141"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "315 W CARPENTER ST",
            "address_2": "1ST FLOOR, CLINIC B",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627024901",
            "telephone_number": "217-545-8000",
            "fax_number": "217-545-1141"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AGAMAH",
        "first_name": "EDEM",
        "middle_name": "S",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-02",
        "last_updated": "2020-10-16",
        "certification_date": "2020-10-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RH0003X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "IL",
            "license": "036085000",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "edemagamah@siusm.allscriptsdirect.net",
            "affiliation": "N",
            "address_1": "315 W Carpenter St",
            "address_2": "1ST FLOOR, CLINIC B",
            "city": "Springfield",
            "state": "IL",
            "country_code": "US",
            "postal_code": "627024901",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Springfield, IL

Sources for this page

Verify at the official NPI Registry.