| St. Elizabeth's Bhs Professional Services | |
|
211 S 3rd St Belleville IL 62220-1915 | |
| (618) 234-2120 | |
| (618) 222-4761 |
| Full Name | St. Elizabeth's Bhs Professional Services |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 211 S 3rd St, Belleville, Illinois |
| Authorized Official Name and Position | Mark D Evard (VP OF REVENUE CYCLE) |
| Authorized Official Contact | 2174929651 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| St. Elizabeth's Bhs Professional Services 3051 Hollis Dr Springfield IL 62704-7450 Ph: (618) 234-2120 | St. Elizabeth's Bhs Professional Services 211 S 3rd St Belleville IL 62220-1915 Ph: (618) 234-2120 |
| NPI Number | 1194736728 |
|---|---|
| Provider Enumeration Date | 08/10/2006 |
| Last Update Date | 10/31/2024 |
| Certification Date | 10/31/2024 |
| Medicare PECOS PAC ID | 6406753011 |
|---|---|
| Medicare Enrollment ID | O20031212000629 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194736728 | NPI | - | NPPES |
| Provider Name | Sherry L Jones |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1912908906 PECOS PAC ID: 1557356789 Enrollment ID: I20040417000233 |
| Provider Name | Thomas Cahill |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1023128113 PECOS PAC ID: 0143241703 Enrollment ID: I20051209000672 |
| Provider Name | Nicholas E Poulos |
|---|---|
| Provider Type | Practitioner - Neurosurgery |
| Provider Identifiers | NPI Number: 1144258310 PECOS PAC ID: 2163439555 Enrollment ID: I20060309000305 |
| Provider Name | Jeffery S Shafer |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1811084551 PECOS PAC ID: 0345206231 Enrollment ID: I20061205000524 |
| Provider Name | Atul Sharad Shah |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1215965660 PECOS PAC ID: 2860471950 Enrollment ID: I20070524000259 |
| Provider Name | Regina Y Chiu |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1043272693 PECOS PAC ID: 8224032586 Enrollment ID: I20070829000328 |
| Provider Name | David F Wallace |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1609804525 PECOS PAC ID: 1951380047 Enrollment ID: I20081010000495 |
| Provider Name | Shiyam K Satwani |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1407067184 PECOS PAC ID: 3870681919 Enrollment ID: I20091014000521 |
| Provider Name | Blake C Rodgers |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1366501140 PECOS PAC ID: 6507992419 Enrollment ID: I20100331000230 |
| Provider Name | Venkatesh Anjan |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1275799850 PECOS PAC ID: 3678751484 Enrollment ID: I20110627000446 |
| Provider Name | John P Scally |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1508952318 PECOS PAC ID: 8527238161 Enrollment ID: I20110927000548 |
| Provider Name | Pavan Kumar Gupta |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1861519563 PECOS PAC ID: 2264525526 Enrollment ID: I20121009000432 |
| Provider Name | Paban Saha |
|---|---|
| Provider Type | Practitioner - Cardiac Electrophysiology |
| Provider Identifiers | NPI Number: 1275698144 PECOS PAC ID: 7113141797 Enrollment ID: I20140623000891 |
| Provider Name | Ashraf Al-dadah |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1457526576 PECOS PAC ID: 0143445650 Enrollment ID: I20140625001201 |
| Provider Name | Basem Khishfe |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1760790802 PECOS PAC ID: 1557580669 Enrollment ID: I20140922001625 |
| Provider Name | Miranda Francis Pogue |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1427324656 PECOS PAC ID: 8921262049 Enrollment ID: I20141023000845 |
| Provider Name | Casandra E Roy |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720474687 PECOS PAC ID: 2567775711 Enrollment ID: I20150721003133 |
| Provider Name | Scott Marrus |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1063578284 PECOS PAC ID: 1254507346 Enrollment ID: I20151201000695 |
| Provider Name | Marianne Guthrie |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609313758 PECOS PAC ID: 0345524583 Enrollment ID: I20170307000704 |
| Provider Name | Michael Jason Hushion |
|---|---|
| Provider Type | Practitioner - Cardiac Electrophysiology |
| Provider Identifiers | NPI Number: 1578887063 PECOS PAC ID: 6406158757 Enrollment ID: I20180710001179 |
| Provider Name | Christina M. Burch |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1619902392 PECOS PAC ID: 8921159898 Enrollment ID: I20191231001215 |
| Provider Name | Lincoln T Shenje |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1700031382 PECOS PAC ID: 7517107006 Enrollment ID: I20200818003473 |
| Provider Name | Frederick Otieno Ochieng |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1497072854 PECOS PAC ID: 3476871963 Enrollment ID: I20200824001186 |
| Provider Name | Benjamin C Beggs |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1386174381 PECOS PAC ID: 5799105995 Enrollment ID: I20201008001896 |
| Provider Name | Alicia E Santel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851902704 PECOS PAC ID: 0345660668 Enrollment ID: I20201026001153 |
| Provider Name | Vinaya C Mulkareddy |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1104207984 PECOS PAC ID: 6608180583 Enrollment ID: I20210721000650 |
| Provider Name | Youssef Hedroug |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1144710385 PECOS PAC ID: 9436554946 Enrollment ID: I20210823000165 |
| Provider Name | Varoon R Thavapalan |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1568740546 PECOS PAC ID: 6709000417 Enrollment ID: I20221216001306 |
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