Individual provider Active NPI

Randy K Sulaver II, M.D.

  • Urology Physician
  • Decatur, IL
National Provider Identifier
1982968756
Registry record updated Apr 20, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
036143964 Issued in IL
Practice address
302 W Hay St Ste 200
Decatur, IL 62526-4171
Phone
(217) 545-8000
Fax
(217) 872-1958
NPI assigned
Jun 26, 2012
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 20, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X 125061943 IL
Urology Physician 208800000X 036143964 IL Primary

Addresses

Primary practice location

302 W Hay St Ste 200
Decatur, IL 62526-4171

Mailing address

201 E Madison St Ste 328
Springfield, IL 62702-5131
Phone (217) 545-8000

Medicare participation

Medicare enrollment files
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: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180710000080 IL Practitioner - Urology 0042450652 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Urology
Education
University of Oklahoma College of Medicine, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Siu Physicians and Surgeons IncGroup PAC ID 2365352820, 316 clinicians

Practice addresses (Care Compare)

302 W Hay St
Suite 200
Decatur, IL 62526-4171
Phone (217) 545-8000

Hospital & facility affiliations

  • Decatur Memorial Hospital Hospital, Decatur, IL, CCN 140135
  • St Marys Hospital Hospital, Decatur, IL, CCN 140166
  • Pana Community Hospital Hospital, Pana, IL, CCN 141341

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as group

Procedures performed for Medicare patients

ProcedureNumber of procedures
Prostate resection11

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
036143964ILMDUrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Board of Trustees of Southern Illinois University Current Accepting new patients
Siu Physicians & Surgeons, Inc CurrentSince Mar 1, 2023 Accepting new patients
Siu Physicians & Surgeons, Inc CurrentSince Mar 1, 2023 Accepting new patients

Locations

302 W Hay St
Ste 200
Decatur, IL 62526
Phone (217) 876-3140

751 N Rutledge St
Springfield, IL 62702
Phone (217) 545-0182

201 E Madison St
Ste 328
Springfield, IL 62702

301 N 8th St
#4B
Springfield, IL 62701
Phone (217) 545-7305

Interoperability endpoints

  • Direct secure messaging: randysulaver@siusm.allscriptsdirect.net

Organizations & group practices 3

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.

Hospital & facility affiliations 3

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": "1340668800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1681948800000",
    "number": "1982968756",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 E MADISON ST STE 328",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627025131",
            "telephone_number": "217-545-8000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "302 W HAY ST STE 200",
            "city": "DECATUR",
            "state": "IL",
            "postal_code": "625264171",
            "telephone_number": "217-545-8000",
            "fax_number": "217-872-1958"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULAVER",
        "first_name": "RANDY",
        "middle_name": "K",
        "name_prefix": "Dr.",
        "name_suffix": "II",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-06-26",
        "last_updated": "2023-04-20",
        "certification_date": "2023-04-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "IL",
            "license": "125061943",
            "primary": false
        },
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "IL",
            "license": "036143964",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Decatur, IL

Sources for this page

Verify at the official NPI Registry.