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SOUTHERN ILLINOIS NEUROPSYCHOLOGY LLC
NPI 1861909509
Clinical Neuropsychologist in Edwardsville, IL

Active since January 03, 2018
60 S STATE ROUTE 157, EDWARDSVILLE, IL 62025(618) 391-4021 Get Directions Write a Review

NPPES record last updated: February 10, 2022. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Feb 10, 2022, Jan 20, 2020, May 22, 2018 (3 updates tracked since 2018).

About Southern Illinois Neuropsychology Llc NPPES

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

SOUTHERN ILLINOIS NEUROPSYCHOLOGY LLC (NPI 1861909509) is a healthcare organization registered as a clinical neuropsychologist in Edwardsville, Illinois and active in the NPI registry since January 2018. The organization lists Phillip Ruppert, Owner, as its authorized official.

NPPES Registry Identity

NPI1861909509
Entity TypeOrganization
Primary Taxonomy103G00000X
Legal Business NameSOUTHERN ILLINOIS NEUROPSYCHOLOGY LLC
Location Address60 S STATE ROUTE 157Edwardsville, IL 62025
Mailing Address1 Oak Dr Unit 352Maryville, IL 62062-7026 · (618) 391-4021
Phone(618) 391-4021
Organization SubpartNo
Authorized OfficialPhillip RuppertOwner · (618) 391-4021
Enumeration DateJanuary 3, 2018
Last NPPES UpdateFebruary 10, 20223 updates tracked since enumeration
NPPES CertifiedFebruary 10, 2022
✔ NPI 1861909509 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinical NeuropsychologistBehavioral Health & Social Service Providers
Taxonomy Code103G00000X
License✔ Licensed in IL · 071009269
Definition
A clinical psychologist who applies principles of assessment and intervention based upon the scientific study of human behavior as it relates to normal and abnormal functioning of the central nervous system. The specialty is dedicated to enhancing the understanding of brain-behavior relationships and the application of such knowledge to human problems.
60 S STATE ROUTE 157, Edwardsville, IL 62025
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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE 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)

Southern Illinois Neuropsychology Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 1 clinician reassigns Medicare billing to Southern Illinois Neuropsychology LLC, which bills Medicare for the services this clinician delivers.

Clinician (1)

Phillip Ruppert, PH.D.
Clinical Psychologist
NPI 1861771206
1438 S GRAND BLVD
Saint Louis, MO 63104
(314) 577-8000
✔ PECOS✔ Accepts Medicare20 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 Southern Illinois Neuropsychology LLC's NPI number?

The NPI number for Southern Illinois Neuropsychology LLC is 1861909509. It was assigned to this organization in the NPPES registry on January 3, 2018.

Where is Southern Illinois Neuropsychology LLC located?

Southern Illinois Neuropsychology LLC is located at 60 S State Route 157, Edwardsville, IL 62025. The listed phone number is (618) 391-4021.

What is Southern Illinois Neuropsychology LLC's specialty?

The primary specialty registered for this NPI is Clinical Neuropsychologist with taxonomy code 103G00000X.

Is Southern Illinois Neuropsychology LLC enrolled in Medicare?

Yes. Southern Illinois Neuropsychology LLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Southern Illinois Neuropsychology LLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Clinical Psychologist) reassigns their Medicare billing to Southern Illinois Neuropsychology 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. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

When was this NPI record last updated?

The NPPES record for Southern Illinois Neuropsychology LLC was last updated on February 10, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years 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.