BOARD OF TRUSTEES OF SOUTHERN ILLINOIS UNIVERSITY
NPI 1104230168
Nurse Practitioner in East Saint Louis, IL

Q: What is Board Of Trustees Of Southern Illinois University's specialty?

The primary specialty registered for this NPI is Nurse Practitioner with taxonomy code 363L00000X.

Active since June 18, 2014

601 JAMES R THOMPSON BLVD, BUILDING D, SUITE 2015, EAST SAINT LOUIS, IL 62201(618) 482-6959(618) 482-8311 Get Directions Write a Review

NPPES record last updated: July 15, 2026. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Jul 15, 2026, Jun 7, 2026, May 15, 2026 and 3 more (6 updates tracked since 2019).

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About Board Of Trustees Of Southern Illinois University NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

BOARD OF TRUSTEES OF SOUTHERN ILLINOIS UNIVERSITY (NPI 1104230168), doing business as Southern Illinois University Edwardsville, is a healthcare organization registered as a nurse practitioner in East Saint Louis, Illinois and active in the NPI registry since June 2014. The organization lists Myjal Garner, Director, as its authorized official.

NPPES Registry Identity

NPI1104230168

Entity TypeOrganization

Primary Taxonomy363L00000X

Legal Business NameBOARD OF TRUSTEES OF SOUTHERN ILLINOIS UNIVERSITY

Location Address601 JAMES R THOMPSON BLVD, BUILDING D, SUITE 2015East Saint Louis, IL 62201-1129

Mailing Address601 James R Thompson Blvd, Building D, Suite 2015East Saint Louis, IL 62201-1129 · (618) 482-6959 · Fax (618) 482-8311

Phone(618) 482-6959

Fax(618) 482-8311

Organization SubpartNo

Authorized OfficialMyjal GarnerDirector · (618) 482-6959

Enumeration DateJune 18, 2014

Last NPPES UpdateJuly 15, 20266 updates tracked since enumeration

NPPES CertifiedJuly 15, 2026

✔ NPI 1104230168 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyNurse PractitionerPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363L00000X

Definition

(1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners.

Also ListedClinic/Center · Multi-SpecialtyTaxonomy 261QM1300X

601 JAMES R THOMPSON BLVD, East Saint Louis, IL 62201

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Other Names 1

Doing Business AsSouthern Illinois University Edwardsville

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Florida Blue (BlueCross BlueShield FL), Florida Blue HMO (a BlueCross BlueShield FL company).Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Board Of Trustees Of Southern Illinois University is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 3 clinicians reassign Medicare billing to Board Of Trustees Of Southern Illinois University, which bills Medicare for the services they deliver. They are listed nearest first.

Clinicians, nearest first (3)

Gayle Ostermiller, FNP-BC

Nurse Practitioner

NPI 1023542602

1296 JEFFCO BLVD
Arnold, MO 63010

(636) 321-8610

✔ PECOS14 mi

Myjal Garner, DNP, APRN, FNP-C

Nurse Practitioner

NPI 1598435372

601 JAMES R THOMPSON BLVD STE 2015
East Saint Louis, IL 62201

(618) 482-6959

✔ PECOS25 mi

Jewel Radford, RN

Nurse Practitioner

NPI 1083397202

601 JAMES R THOMPSON BLVD STE 2015
East Saint Louis, IL 62201

(618) 482-6959

✔ PECOS✔ Accepts Medicare25 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Board Of Trustees Of Southern Illinois University's NPI number?

The NPI number for Board Of Trustees Of Southern Illinois University is 1104230168. It was assigned to this organization in the NPPES registry on June 18, 2014. The provider is doing business as Southern Illinois University Edwardsville.

Where is Board Of Trustees Of Southern Illinois University located?

Board Of Trustees Of Southern Illinois University is located at 601 James R Thompson Blvd Building D, Suite 2015, East Saint Louis, IL 62201. The listed phone number is (618) 482-6959.

What is Board Of Trustees Of Southern Illinois University's specialty?

The primary specialty registered for this NPI is Nurse Practitioner with taxonomy code 363L00000X.

Is Board Of Trustees Of Southern Illinois University enrolled in Medicare?

Yes. Board Of Trustees Of Southern Illinois University is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Board Of Trustees Of Southern Illinois University?

According to the CMS Revalidation Reassignment List (October 2026 release), 3 clinicians, all in Nurse Practitioner, reassign their Medicare billing to Board Of Trustees Of Southern Illinois University. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

What insurance does Board Of Trustees Of Southern Illinois University accept?

Health plans from Florida Blue (BlueCross BlueShield FL) and Florida Blue HMO (a BlueCross BlueShield FL company) list Board Of Trustees Of Southern Illinois University as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Board Of Trustees Of Southern Illinois University was last updated on July 15, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.