NPIMap

Individual provider Active NPI

Tibor Charles Kopjas, M.D.

  • Internal Medicine Physician
  • Maryville, IL
National Provider Identifier
1952332918
Registry record updated Aug 28, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
036070084 Issued in IL
Practice address
6812 State Route 162 Ste 209
Maryville, IL 62062-8562
Phone
(618) 391-5061
Fax
(618) 205-3923
NPI assigned
Jul 6, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 28, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 036070084 IL Primary

Addresses

Primary practice location

6812 State Route 162 Ste 209
Maryville, IL 62062-8562

Mailing address

6810 State Route 162 Box 215
Maryville, IL 62062-8501
Phone (618) 391-6405

Other practice location 1

2118 Vadalabene Dr
Maryville, IL 62062-5632
Phone (618) 288-7081

Other identifiers 6

IdentifierTypeStateIssuer
06000515OtherILBLUE CROSS
166459OtherILGHP
100767OtherILHEALTHLINK
110016002OtherILRIALROAD MEDICARE
036070084MedicaidIL
0407247OtherILUNITED HEALTH

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
I20071120000554 IL Practitioner - Internal Medicine 5698863975 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
University of Missouri, Columbia School of Medicine, 1983
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Anderson Medical Group LLCGroup PAC ID 5193792018, 136 clinicians

Practice addresses (Care Compare)

2928 N Ctr St
Maryville, IL 62062-5628
Phone (618) 391-5061

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
74.76 of 100Reported as group
Quality
54.98
Promoting interoperability
85
Improvement activities
40
Cost
73.39

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Anderson Medical Group, LLC Internal Medicine CurrentSince Aug 12, 2015 Accepting new patients
Illinois Ear, Nose and Throat Associates, P.C PastSince Feb 23, 2020 Accepting new patients
Ozarks Medical Center Past Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients

Locations

1095 University Dr
Edwardsville, IL 62025
Phone (618) 391-6495

6812 State Route 162
Ste 209
Maryville, IL 62062
Phone (618) 288-1960

6800 State Route 162
Maryville, IL 62062
Phone (618) 288-4095

2928 N Center St
Maryville, IL 62062
Phone (618) 222-8900

2102 Vadalabene Dr
Maryville, IL 62062
Phone (618) 288-4350

2118 Vadalabene Dr
Maryville, IL 62062
Phone (618) 288-5430

6955 State Route 162
Maryville, IL 62062
Phone (618) 288-3800

2118 Vadalabene Dr
#A
Maryville, IL 62062
Phone (618) 288-5430

6810 State Route 162
Ste 215
Maryville, IL 62062
Phone (618) 391-6405

Organizations & group practices 4

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 10

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": "1152144000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724803200000",
    "number": "1952332918",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6810 STATE ROUTE 162 BOX 215",
            "city": "MARYVILLE",
            "state": "IL",
            "postal_code": "620628501",
            "telephone_number": "618-391-6405",
            "fax_number": "618-288-4088"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6812 STATE ROUTE 162 STE 209",
            "city": "MARYVILLE",
            "state": "IL",
            "postal_code": "620628562",
            "telephone_number": "618-391-5061",
            "fax_number": "618-205-3923"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2118 Vadalabene Dr",
            "address_purpose": "LOCATION",
            "city": "Maryville",
            "state": "IL",
            "postal_code": "620625632",
            "country_code": "US",
            "telephone_number": "618-288-7081",
            "fax_number": "618-288-6857",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KOPJAS",
        "first_name": "TIBOR",
        "middle_name": "CHARLES",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-06",
        "last_updated": "2024-08-28",
        "certification_date": "2024-08-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036070084",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "06000515",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GHP",
            "identifier": "166459",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHLINK",
            "identifier": "100767",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RIALROAD MEDICARE",
            "identifier": "110016002",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036070084",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTH",
            "identifier": "0407247",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Maryville, IL

Sources for this page

Verify at the official NPI Registry.