Southern Illinois Family Foot Care, LLC

Primary specialty

Medical Specialty Clinic/CenterTaxonomy code 261QM2500X

License

016003846 Issued in IL

Legal business name

SOUTHERN ILLINOIS FAMILY FOOT CARE, LLC

Practice address

221 N 27TH St
Mount Vernon, IL 62864-2941

Phone

(618) 244-3668

NPI assigned

Feb 17, 2013

Last updated

May 16, 2014By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Brian Lee, D.P.M.NPI 1285744060

Title

President

Phone

(618) 244-3668

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

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

CLIA laboratory certificates

Practitioners 1

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.

• Brian R Lee

  • Podiatrist
  • Mount Vernon, IL
  • NPI 1285744060
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1361059200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1400198400000",
    "number": "1972843613",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "221 N 27TH ST",
            "city": "MOUNT VERNON",
            "state": "IL",
            "postal_code": "628642941",
            "telephone_number": "618-244-3668"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "221 N 27TH ST",
            "city": "MOUNT VERNON",
            "state": "IL",
            "postal_code": "628642941",
            "telephone_number": "618-244-3668"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN ILLINOIS FAMILY FOOT CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-02-17",
        "last_updated": "2014-05-16",
        "status": "A",
        "authorized_official_last_name": "LEE",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "618-244-3668",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.P.M."
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": "IL",
            "license": "016003846",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1285744060",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Samantha Tianna Someske, LPN
• Jonathan L Sorenson, CRNA
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• Southern Illinois Anesthesiology LTD
• Southern Illinois Consultants for Kidney Disease, S.C.
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• Southside Medical Clinic Inc
• Spero Family Services
• Spero Family Services
• Spero Family Services

• Medical Specialty Clinic/Center in Mount Vernon, IL
• Providers in Mount Vernon, IL by specialty
• Medical Specialty Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2014; 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.