NPIMap

Organization Active NPI

Southern Illinois Pain Management

  • Specialist
  • Marion, IL
National Provider Identifier
1942227863
Registry record updated Jan 18, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
SOUTHERN ILLINOIS PAIN MANAGEMENT
Practice address
3905 W Ernestine Dr
Marion, IL 62959-5800
Phone
(618) 993-5859
Fax
(618) 997-1588
NPI assigned
Jul 16, 2006
Last updated
Jan 18, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 18, 2011

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

Authorized official

Name
Mr. Paul Brian Juergens, M.DNPI 1922026673
Title
Owner/Physician
Phone
(618) 993-5859

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X Primary

Addresses

Primary practice location

3905 W Ernestine Dr
Marion, IL 62959-5800

Mailing address

3905 W Ernestine Dr
Marion, IL 62959-5800
Phone (618) 993-5859

National Provider Directory

National Provider Directory

Locations

4119 S Water Tower Pl
Mount Vernon, IL 62864
Phone (618) 241-8505

101 N Walnut St
Pinckneyville, IL 62274
Phone (618) 357-2131

Practitioners & affiliated clinicians

Practitioners 11

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.

NPI Registry JSON

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

{
    "created_epoch": "1153008000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1295308800000",
    "number": "1942227863",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3905 W ERNESTINE DR",
            "city": "MARION",
            "state": "IL",
            "postal_code": "629595800",
            "telephone_number": "618-993-5859",
            "fax_number": "618-997-1588"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3905 W ERNESTINE DR",
            "city": "MARION",
            "state": "IL",
            "postal_code": "629595800",
            "telephone_number": "618-993-5859",
            "fax_number": "618-997-1588"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN ILLINOIS PAIN MANAGEMENT",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-16",
        "last_updated": "2011-01-18",
        "status": "A",
        "authorized_official_last_name": "JUERGENS",
        "authorized_official_first_name": "PAUL",
        "authorized_official_middle_name": "BRIAN",
        "authorized_official_title_or_position": "OWNER/PHYSICIAN",
        "authorized_official_telephone_number": "618-993-5859",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "M.D"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Marion, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.