Nidhi Priya

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

019032833 Issued in IL

Practice address

3115 Williamson County Pkwy
Marion, IL 62959-5235

Phone

(618) 519-9200

Fax

(618) 997-1214

NPI assigned

Jul 24, 2020

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/14668/brand/2/csg/1/fhir/r4

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.

• Shawnee Health Service & Development Corp

  • Federally Qualified Health Center (FQHC)
  • Carbondale, IL
  • NPI 1174859870
  NPD (past)
• Shawnee Health Service and Development Corp

  • Federally Qualified Health Center (FQHC)
  • Marion, IL
  • NPI 1356677058
  NPD (past)

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

{
    "created_epoch": "1595548800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1652140800000",
    "number": "1962011080",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "109 CALIFORNIA ST",
            "address_2": "PO BOX 577",
            "city": "CARTERVILLE",
            "state": "IL",
            "postal_code": "629180577",
            "telephone_number": "618-519-9200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3115 WILLIAMSON COUNTY PKWY",
            "city": "MARION",
            "state": "IL",
            "postal_code": "629595235",
            "telephone_number": "618-519-9200",
            "fax_number": "618-997-1214"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRIYA",
        "first_name": "NIDHI",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-07-24",
        "last_updated": "2022-05-10",
        "certification_date": "2022-05-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019032833",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jamie Preston, LMSW
• Vanessa Primo
• Amanda Prince, LPN
• Philis Jean Prince
• Priority Integrated Healthcare PC
• PRN Pharmacies LTD
• Professional Therapeutic Group, LLC
• Promed Preferred Il 3 PLLC
• Prorehab PC
• Daniel Prudencio

• All providers in Marion, IL
• General Practice Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.