SIU CENTER FOR FAMILY MEDICINE - GENERAL INTERNAL MEDICINE CLINIC
NPI 1679188437
Clinic/Center - Federally Qualified Health Center (FQHC) in Springfield, IL

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

The primary specialty registered for this NPI is Clinic/Center, specializing in Federally Qualified Health Center (FQHC), with taxonomy code 261QF0400X.

Active since September 09, 2020

751 N RUTLEDGE ST STE 1100, SPRINGFIELD, IL 62702(217) 545-8000(217) 545-4735 Get Directions Write a Review

NPPES record last updated: January 9, 2025. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Jan 9, 2025, Nov 17, 2022, Mar 18, 2021 and 2 more (5 updates tracked since 2020).

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About Siu Center For Family Medicine - General Internal Medicine Clinic NPPES

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

SIU CENTER FOR FAMILY MEDICINE - GENERAL INTERNAL MEDICINE CLINIC (NPI 1679188437) is a healthcare organization registered as a federally qualified health center (fqhc) in Springfield, Illinois and active in the NPI registry since September 2020. The organization maintains a secondary practice location in Springfield and lists Iris Wesley, Ceo, as its authorized official.

NPPES Registry Identity

NPI1679188437

Entity TypeOrganization

Primary Taxonomy261QF0400X

Legal Business NameBOARD OF TRUSTEES OF SOUTHERN ILLINOIS UNIVERSITY

Location Address751 N RUTLEDGE ST STE 1100Springfield, IL 62702-4968

Mailing AddressPo Box 19639Springfield, IL 62794-9639 · (217) 545-7876

Phone(217) 545-8000

Fax(217) 545-4735

Organization SubpartYes

Authorized OfficialIris WesleyCeo · (217) 545-8000

Enumeration DateSeptember 9, 2020

Last NPPES UpdateJanuary 9, 20255 updates tracked since enumeration

NPPES CertifiedJanuary 9, 2025

✔ NPI 1679188437 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyClinic/Center · Federally Qualified Health Center (FQHC)Ambulatory Health Care Facilities

Taxonomy Code261QF0400X

Also ListedClinic/Center · Primary CareTaxonomy 261QP2300X

751 N RUTLEDGE ST STE 1100, Springfield, IL 62702

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Other Names 1

Doing Business AsSiu Center For Family Medicine - General Internal Medicine Clinic

Secondary Practice Location 1

Location 1747 N Rutledge St Ste 2287-BSpringfield, IL 62702-6700 · Phone (217) 545-8000

Medicare Participation & PECOS CMS

Medicare enrollment and revalidation status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Siu Center For Family Medicine - General Internal Medicine Clinic is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Medicare Revalidation Due Date

Revalidation due by October 31, 2026

Medicare-enrolled providers and suppliers confirm their enrollment information with CMS on a set cycle, every 5 years for most and every 3 years for medical equipment suppliers. CMS sets the due date for each enrollment.

StateEnrollment IDDue date

StateIllinoisEnrollment IDO20210903000716Part A · Federally Qualified Health Center (FQHC)Due dateOctober 31, 2026

Source: CMS Revalidation Due Date List, October 2026 release.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

ANAND PATEL PHARMD

Pharmacist (Ambulatory Care)