Organization Active NPI

Southern Illinois Associates LLC

  • Psychiatry Physician
  • Maryville, IL
National Provider Identifier
1962427856
Registry record updated Apr 6, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
SOUTHERN ILLINOIS ASSOCIATES LLC
Practice address
6805 State Route 162 Ste 201
Maryville, IL 62062-8530
Phone
(618) 288-5019
Fax
(618) 288-5059
NPI assigned
Jul 13, 2006
Last updated
Apr 6, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 6, 2026

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

Authorized official

Name
Sanjay Nigam, MDNPI 1942278973
Title
President
Phone
(618) 288-5019

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X
Psychiatry Physician 2084P0800X Primary

Addresses

Primary practice location

6805 State Route 162 Ste 201
Maryville, IL 62062-8530

Mailing address

6805 State Route 162 Ste 201
Maryville, IL 62062-8530
Phone (618) 288-5019

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040707000602 IL Part B Supplier - Clinic/Group Practice 2961489992 Receives reassigned benefits from 18 practitioners
Practice locations: Maryville, IL

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
14D2225919Southern Illinois Associates LLC6805 State Route 162 - Ste 201, Maryville, IL 62062Certificate of waiverMay 24, 2027

National Provider Directory

National Provider Directory

Locations

450 W 1st St
Aviston, IL 62216
Phone (218) 228-7615

512 S Franklin St
Bunker Hill, IL 62014
Phone (618) 585-4875

1121 University Dr
Ste 4
Edwardsville, IL 62025
Phone (618) 659-8706

7325 Marine Rd
Edwardsville, IL 62025
Phone (618) 307-5816

16 Junction Dr W
#2
Glen Carbon, IL 62034
Phone (618) 288-5019

241 Magnolia Dr
Glen Carbon, IL 62034
Phone (618) 288-1863

6805 Highway 162
#201
Maryville, IL 62062
Phone (618) 288-5019

6805 State Route 162
#201
Maryville, IL 62062
Phone (618) 288-5019

6805 State Route 162
Ste 101
Maryville, IL 62062
Phone (618) 205-3285

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

901 N 10th St
Mascoutah, IL 62258
Phone (618) 556-2183

1924 Sra Bradley R Smith Dr
#A
Troy, IL 62294
Phone (618) 667-2025

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/17590/brand/1/csg/1/fhir/r4
  • FHIR API: https://fhir4.healow.com/fhir/r4/AFHDDD

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": "1152748800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1775433600000",
    "number": "1962427856",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6805 STATE ROUTE 162 STE 201",
            "city": "MARYVILLE",
            "state": "IL",
            "postal_code": "620628530",
            "telephone_number": "618-288-5019",
            "fax_number": "618-288-5059"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6805 STATE ROUTE 162 STE 201",
            "city": "MARYVILLE",
            "state": "IL",
            "postal_code": "620628530",
            "telephone_number": "618-288-5019",
            "fax_number": "618-288-5059"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN ILLINOIS ASSOCIATES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-13",
        "last_updated": "2026-04-06",
        "certification_date": "2026-04-06",
        "status": "A",
        "authorized_official_last_name": "NIGAM",
        "authorized_official_first_name": "SANJAY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "618-288-5019",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Maryville, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.