NPIMap

Individual provider Active NPI

Philipos Kidane Gebremedhin, MD

  • Surgery Physician
  • Springfield, IL
National Provider Identifier
1932691631
Registry record updated Jul 29, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
036.174691 Issued in IL
Practice address
747 N Rutledge St FL 4
Springfield, IL 62702-6700
Phone
(217) 545-8000
Fax
(217) 545-7053
NPI assigned
May 30, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 29, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 036.174691 IL Primary

Addresses

Primary practice location

747 N Rutledge St FL 4
Springfield, IL 62702-6700

Mailing address

PO Box 19639
Springfield, IL 62794-9639
Phone (217) 545-8000

Other practice location 1

701 N 1st St Ste D308
Springfield, IL 62702-3757
Phone (217) 545-4401

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
I20250818002892 IL Practitioner - General Surgery 3779830740 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
Other, 2009
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)

747 N Rutledge St
Springfield, IL 62702-6700
Phone (217) 545-8000

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Coronary artery bypass graft (CABG)27
Upper gastrointestinal (GI) endoscopy for acid reflux1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036.174691ILMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Board of Trustees of Southern Illinois University Current Accepting new patients
Siu Physicians & Surgeons, Inc CurrentSince Aug 7, 2025 Accepting new patients
Siu Physicians & Surgeons, Inc CurrentSince Aug 7, 2025 Accepting new patients

Locations

747 N Rutledge St
Springfield, IL 62702
Phone (217) 545-6112

747 N Rutledge St
Fl 4
Springfield, IL 62702

751 N Rutledge St
Springfield, IL 62702
Phone (217) 545-0182

701 N 1st St
Ste D308
Springfield, IL 62702
Phone (217) 545-4401

Interoperability endpoints

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

Organizations & group practices 3

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

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": "1527638400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1753747200000",
    "number": "1932691631",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 19639",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627949639",
            "telephone_number": "217-545-8000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "747 N RUTLEDGE ST FL 4",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627026700",
            "telephone_number": "217-545-8000",
            "fax_number": "217-545-7053"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "701 N 1st St Ste D308",
            "address_purpose": "LOCATION",
            "city": "Springfield",
            "state": "IL",
            "postal_code": "627023757",
            "country_code": "US",
            "telephone_number": "217-545-4401",
            "fax_number": "217-545-1793",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GEBREMEDHIN",
        "first_name": "PHILIPOS",
        "middle_name": "KIDANE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-05-30",
        "last_updated": "2025-07-29",
        "certification_date": "2025-07-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "IL",
            "license": "036.174691",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Springfield, IL

Sources for this page

Verify at the official NPI Registry.