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ADVANCED SURGICAL TECHNOLOGY, LLC
NPI 1497159024
Surgery in Centralia, IL

Active since October 10, 2014CLIA Certified · 4 labs
1307 E MCCORD ST, CENTRALIA, IL 62801(618) 899-9200(618) 899-9206 Get Directions Write a Review

NPPES record last updated: September 9, 2026. Verified against the NPPES registry weekly; last sync: November 01, 2026.

Record update history: Sep 9, 2026, Jul 17, 2019 (2 updates tracked since 2019).

About Advanced Surgical Technology, Llc NPPES

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

ADVANCED SURGICAL TECHNOLOGY, LLC (NPI 1497159024) is a healthcare organization registered as a surgery in Centralia, Illinois and active in the NPI registry since October 2014. The organization holds 4 active CLIA laboratory certificates, maintains 2 additional practice locations, and lists Jennia Rensing, Office Manager, as its authorized official.

NPPES Registry Identity

NPI1497159024
Entity TypeOrganization
Primary Taxonomy208600000X
Legal Business NameADVANCED SURGICAL TECHNOLOGY, LLC
Location Address1307 E MCCORD STCentralia, IL 62801-3610
Mailing Address1307 E Mccord StCentralia, IL 62801-3610 · (618) 899-9200 · Fax (618) 899-9206
Phone(618) 899-9200
Fax(618) 899-9206
Organization SubpartNo
Authorized OfficialJennia RensingOffice Manager · (618) 899-9200
Enumeration DateOctober 10, 2014
Last NPPES UpdateSeptember 9, 20262 updates tracked since enumeration
NPPES CertifiedSeptember 9, 2026
✔ NPI 1497159024 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySurgeryAllopathic & Osteopathic Physicians
Taxonomy Code208600000X
License✔ Licensed in IL · 036115674
Definition
A general surgeon has expertise related to the diagnosis - preoperative, operative and postoperative management - and management of complications of surgical conditions in the following areas: alimentary tract; abdomen; breast, skin and soft tissue; endocrine system; head and neck surgery; pediatric surgery; surgical critical care; surgical oncology; trauma and burns; and vascular surgery. General surgeons increasingly provide care through the use of minimally invasive and endoscopic techniques. Many general surgeons also possess expertise in transplantation surgery, plastic surgery and cardiothoracic surgery.
1307 E MCCORD ST, Centralia, IL 62801
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Secondary Practice Locations 2

Location 1400 Rushing DrHerrin, IL 62948-3762 · Phone (618) 942-9497
Location 23120 Veterans Memorial DrMount Vernon, IL 62864-5951 · Phone (618) 899-9533 · Fax (618) 899-9534

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Advanced Surgical Technology, Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

10

Medicare enrollment records show 10 clinicians reassign Medicare billing to Advanced Surgical Technology, LLC, which bills Medicare for the services they deliver. Of these, 1 practice at this address and 4 within 10 miles. They are listed nearest first.

Clinicians by Medicare Specialty 3

Nurse Practitioner5
Diagnostic Radiology3
General Surgery2

Clinicians, nearest first (10)

Kylie Newcomb
Nurse Practitioner
NPI 1669334587
1307 E MCCORD ST
Centralia, IL 62801
(618) 899-9200
✔ PECOS✔ Accepts MedicareSame address
Abbey Dempsey
Nurse Practitioner
NPI 1104287598
1307 E MCCORD ST
Centralia, IL 62801
(618) 899-9200
✔ PECOS✔ Accepts Medicare0.1 mi
Merrilee Brandt, M.D.
General Surgery
NPI 1942243811
1054 MARTIN LUTHER KING DR SUITE 125
Centralia, IL 62801
(618) 436-5200
✔ PECOS✔ Accepts Medicare1.4 mi
Jana Tull, APN
Nurse Practitioner
NPI 1588105654
400 N PLEASANT AVE
Centralia, IL 62801
(618) 436-8000
✔ PECOS✔ Accepts Medicare2.3 mi
Kelsey Carter, NP
Nurse Practitioner
NPI 1386304764
1297 FRANKLIN ST
Carlyle, IL 62231
(618) 227-7229
✔ PECOS✔ Accepts Medicare13 mi
Macey Gettinger
Nurse Practitioner
NPI 1912528126
4200 WILLIAMSON PL STE 1A
Mount Vernon, IL 62864
(618) 899-9200
✔ PECOS✔ Accepts Medicare20 mi
Udaya Liyanage, MD
General Surgery
NPI 1972548287
4200 WILLIAMSON PL STE 1A
Mount Vernon, IL 62864
(618) 899-9200
✔ PECOS✔ Accepts Medicare20 mi
John Willis, MD
Diagnostic Radiology
NPI 1326095670
1 GOOD SAMARITAN WAY
Mount Vernon, IL 62864
(618) 242-4600
✔ PECOS✔ Accepts Medicare22 mi
Hisham Youssef, MD RADIOLOGIST
Diagnostic Radiology
NPI 1720078629
112 E CLARK ST
Harrisburg, IL 62946
(618) 252-8337
✔ PECOS✔ Accepts Medicare65 mi
Randy Balmforth, D.O.
Diagnostic Radiology
NPI 1366642738
GARDEN CITY HOSPITAL 6245 INKSTER ROAD
Garden City, MI 48135
(734) 421-3300
✔ PECOS✔ Accepts Medicare401 mi

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

CLIA Laboratory Certificates CMS CLIA 4

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Compliance 14D2292466

Advanced Surgical Technology LLC · Mount Vernon, IL
Active · expires Nov 14, 2028
CLIA Number14D2292466
Laboratory TypePhysician Office
Certificate Effective DateNovember 15, 2026
Certificate Expiration DateNovember 14, 2028
Laboratory DirectorUdaya K. Liyanage
Laboratory Phone(618) 899-9533
Laboratory LocationAdvanced Surgical Technology LLC3120 Veterans Memorial Drive, Mount Vernon, IL 62864
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.

Certificate of Waiver 14D2231713

Advanced Surgical Technology, LLC · Centralia, IL
Active · expires Jan 7, 2028
CLIA Number14D2231713
Laboratory TypePhysician Office
Certificate Effective DateJanuary 8, 2026
Certificate Expiration DateJanuary 7, 2028
Laboratory DirectorUdaya K. Liyanage
Laboratory Phone(618) 899-9200
Laboratory LocationAdvanced Surgical Technology, LLC1307 E Mccord, Centralia, IL 62801
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Compliance 14D2256857

Advanced Surgical Technology, LLC · Herrin, IL
Active · expires Jan 17, 2028
CLIA Number14D2256857
Laboratory TypePhysician Office
Certificate Effective DateJanuary 18, 2026
Certificate Expiration DateJanuary 17, 2028
Laboratory DirectorUdaya K. Liyanage
Laboratory Phone(618) 942-9585
Laboratory LocationAdvanced Surgical Technology, LLC400 Rushing Dr, Herrin, IL 62948
CLIA data matches this NPI record on: Address Name
This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.

Certificate of Waiver 14D2172502

Advanced Surgical Technology, L L C · Mount Vernon, IL
Active · expires Mar 1, 2027
CLIA Number14D2172502
Laboratory TypePhysician Office
Certificate Effective DateMarch 2, 2025
Certificate Expiration DateMarch 1, 2027
Laboratory DirectorUdaya K. Liyanage M D
Laboratory Phone(618) 899-9200
Laboratory LocationAdvanced Surgical Technology, L L C4200 Williamson Pl - Ste 1A, Mount Vernon, IL 62864
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

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 Advanced Surgical Technology, LLC's NPI number?

The NPI number for Advanced Surgical Technology, LLC is 1497159024. It was assigned to this organization in the NPPES registry on October 10, 2014.

Where is Advanced Surgical Technology, LLC located?

Advanced Surgical Technology, LLC is located at 1307 E Mccord St, Centralia, IL 62801. The listed phone number is (618) 899-9200.

What is Advanced Surgical Technology, LLC's specialty?

The primary specialty registered for this NPI is Surgery with taxonomy code 208600000X.

Is Advanced Surgical Technology, LLC enrolled in Medicare?

Yes. Advanced Surgical Technology, LLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Advanced Surgical Technology, LLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 10 clinicians in 3 Medicare specialties reassign their Medicare billing to Advanced Surgical Technology, LLC. 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. The largest specialties are Nurse Practitioner (5), Diagnostic Radiology (3) and General Surgery (2). Of these, 1 practice at this address and 4 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Advanced Surgical Technology, LLC hold CLIA laboratory certificates?

Yes. 4 active CLIA laboratory certificates are associated with this NPI under the federal Clinical Laboratory Improvement Amendments program. The certificates are listed in the CLIA Laboratory Certificates section above.

When was this NPI record last updated?

The NPPES record for Advanced Surgical Technology, LLC was last updated on September 9, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 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.