NPIMap

Individual provider Active NPI

Max A Baier, NP

  • Nurse Practitioner
  • West Frankfort, IL
National Provider Identifier
1972589919
Registry record updated Dec 20, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
209004084 Issued in IL
Practice address
2553 Ken Gray Blvd
West Frankfort, IL 62896-4174
Phone
(618) 932-3937
Fax
(618) 932-2734
NPI assigned
Dec 21, 2005
Last updated
Dec 20, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 20, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 209004084 IL Primary
Medical Physician Assistant 363AM0700X 085-000253 IL

Addresses

Primary practice location

2553 Ken Gray Blvd
West Frankfort, IL 62896-4174

Mailing address

300 W Oak St
Carbondale, IL 62901-1400
Phone (618) 932-3937

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
I20170130001618 IL Practitioner - Nurse Practitioner 3173805058 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 1982
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Board of Trustees of Southern Illinois UniversityGroup PAC ID 4486667888, shared by 19 NPIs, 139 clinicians

Practice addresses (Care Compare)

2553 Ken Gray Blvd
W Frankfort, IL 62896-4174
Phone (618) 932-2155

300 W Oak St
Carbondale, IL 62901-1400
Phone (618) 536-6621

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
085-000253ILMDMedical Physician Assistant
209004084ILMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Southern Illinois Hospital Services CurrentSince Dec 1, 2016 Accepting new patients
Siu Physicians & Surgeons, Inc CurrentSince Dec 1, 2016 Accepting new patients
Board of Trustees of Southern Illinois University Current Accepting new patients
Premise Health of Illinois Medical PC CurrentSince Apr 18, 2019 Accepting new patients
Premise Health of Illinois Medical PC CurrentSince Apr 18, 2019 Accepting new patients
Southern Illinois Hospital Services Current Accepting new patients
Siu Physicians & Surgeons, Inc CurrentSince Dec 1, 2016 Accepting new patients
Southern Illinois Hospital Services CurrentSince Dec 1, 2016 Accepting new patients
Southern Illinois University Past Accepting new patients

Locations

305 W Jackson St
Ste 200
Carbondale, IL 62901
Phone (618) 453-3777

16906 Collection Ctr Dr
Chicago, IL 60693

5100 Lake Ter NE
Mount Vernon, IL 62864
Phone (618) 244-8793

301 N 8th St
Springfield, IL 62701
Phone (217) 545-0003

2553 Ken Gray Blvd
West Frankfort, IL 62896
Phone (618) 932-2155

Interoperability endpoints

  • Direct secure messaging: maxbaier@siusm.allscriptsdirect.net
  • Direct secure messaging: mbaier13370@sih.direct-ci.com

Organizations & group practices 9

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

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": "1135123200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639958400000",
    "number": "1972589919",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 W OAK ST",
            "city": "CARBONDALE",
            "state": "IL",
            "postal_code": "629011400",
            "telephone_number": "618-932-3937"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2553 KEN GRAY BLVD",
            "city": "WEST FRANKFORT",
            "state": "IL",
            "postal_code": "628964174",
            "telephone_number": "618-932-3937",
            "fax_number": "618-932-2734"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BAIER",
        "first_name": "MAX",
        "middle_name": "A",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-21",
        "last_updated": "2021-12-20",
        "certification_date": "2021-12-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IL",
            "license": "209004084",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "IL",
            "license": "085-000253",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in West Frankfort, IL

Sources for this page

Verify at the official NPI Registry.