Leon Gauthier, PA-C
Individual provider Active NPI Physician Assistant · Herrin, IL
NPI 1033145172 · NPPES record last updated Jul 9, 2007
Key facts
- NPI
- 1033145172
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 085000934 (IL)
- Practice address
- 220 N Park Ave
Suite 2
Herrin, IL 62948-3150 - Phone
- (618) 942-3344
- Fax
- (618) 942-5045
- NPI assigned
- Jun 23, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 8
Hospital & facility affiliations 7
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- University of North Dakota School of Medicine, 1997
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Community Health and Emergency Services Inc
Practice addresses (Care Compare)
13245 Kessler Rd
Cairo, IL 62914-3101
Phone (618) 734-4400
Hospital & facility affiliations
- Harrisburg Medical Center
- Ferrell Hospital Community Foundations
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20101019001531 | IL | Practitioner - Physician Assistant | 9436342763 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 085000934 | IL | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Community Health & Emergency Services, Inc. | Current |
Accepting new patients | |
| Southernmost Illinois Community Health Improvement Corporation | Current | Accepting new patients |
Locations
1400 W Main St
Carmi, IL 62821
Phone (618) 382-4181
205 N Main St
Harrisburg, IL 62946
Phone (618) 253-8450
Interoperability endpoints
- leon.gauthier.p1@direct.chesi.nextgenshare.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 085000934 | IL | Yes |
Addresses
Primary practice location
220 N Park Ave
Suite 2
Herrin, IL 62948-3150
Mailing address
220 N Park Ave
Suite 2
Herrin, IL 62948-3150
Phone (618) 942-3344
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 371359450 | Other | IL | FEDERAL EMPLOYER ID NUMBE |
| 441379 | Other | IL | HEALTHLINK HMO/PPO PROV # |
| CB3700 | Other | IL | RAILROAD MEDICARE GROUP |
| L84852 | Other | IL | UMWA PROVIDER NUMBER |
| 970023073 | Other | IL | RAILROAD PROVIDER NUMBER |
Other providers in Herrin, IL
- Robin Gallo
- Gunnar M Galloway
- Tamela Gamble
- Joana Caldeo Garcia
- Gastroenterology Care of Southern Illinois, LLC
- Chanavia Marquetta Givens
- Terrence Glennon
- Macy Lane Goins
- Robert J Golz
- Marta Gonzales
All providers in Herrin, IL · Physician Assistant in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 9, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.