NPIMap

Organization Active NPI

Midwest Sinus Sleep & Allergy Associates, LLC

  • Otolaryngology Physician
  • Mount Vernon, IL
National Provider Identifier
1962000513
Registry record updated Jan 4, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
Legal business name
MIDWEST SINUS SLEEP & ALLERGY ASSOCIATES, LLC
Practice address
4224 Lincolnshire Dr Ste B
Mount Vernon, IL 62864-2156
Phone
(618) 816-0715
Fax
(888) 371-4468
NPI assigned
Oct 15, 2020
Last updated
Jan 4, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 4, 2021

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

Authorized official

Name
Kelli BlaggNPI 1679676738
Title
Office Manager
Phone
(618) 628-0715

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
Otolaryngology Physician 207Y00000X NU Primary

Addresses

Primary practice location

4224 Lincolnshire Dr Ste B
Mount Vernon, IL 62864-2156

Mailing address

4224 Lincolnshire Dr Ste B
Mount Vernon, IL 62864-2156
Phone (618) 816-0715

Other identifiers 1

IdentifierTypeStateIssuer
137681642OtherILNEW ENTITY

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address kshahmd@hotmail.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210128002083 IL Part B Supplier - Clinic/Group Practice 1850705096 Receives reassigned benefits from 13 practitioners
Practice locations: Waterloo, IL; Shiloh, IL; Red Bud, IL; Mount Vernon, IL; Flora, IL; Jerseyville, IL; Greenville, IL; Highland, IL…

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

4224 Lincolnshire Dr
#B
Mount Vernon, IL 62864
Phone (618) 242-0101

1179 Fortune Blvd
Shiloh, IL 62269
Phone (309) 368-8984

Practitioners & affiliated clinicians

Practitioners 21

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.

View all 21

NPI Registry JSON

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

{
    "created_epoch": "1602720000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1609718400000",
    "number": "1962000513",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4224 LINCOLNSHIRE DR STE B",
            "city": "MOUNT VERNON",
            "state": "IL",
            "postal_code": "628642156",
            "telephone_number": "618-816-0715",
            "fax_number": "888-371-4468"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4224 LINCOLNSHIRE DR STE B",
            "city": "MOUNT VERNON",
            "state": "IL",
            "postal_code": "628642156",
            "telephone_number": "618-816-0715",
            "fax_number": "888-371-4468"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIDWEST SINUS SLEEP & ALLERGY ASSOCIATES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-15",
        "last_updated": "2021-01-04",
        "certification_date": "2021-01-04",
        "status": "A",
        "authorized_official_last_name": "BLAGG",
        "authorized_official_first_name": "KELLI",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "618-628-0715"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NEW ENTITY",
            "identifier": "137681642",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kshahmd@hotmail.com",
            "affiliation": "N",
            "address_1": "4224 Lincolnshire Dr Ste B",
            "city": "Mount Vernon",
            "state": "IL",
            "country_code": "US",
            "postal_code": "628642156",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Mount Vernon, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.