Individual provider Active NPI

Abigail Rose Sutton, PA-C

  • Physician Assistant
  • Peoria, IL
National Provider Identifier
1033830195
Registry record updated Sep 7, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
085.009024 Issued in IL
Practice address
303 N William Kumpf Blvd
Peoria, IL 61605-2507
Phone
(309) 676-5546
Fax
(309) 676-5045
NPI assigned
Sep 7, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 7, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 085.009024 IL Primary

Addresses

Primary practice location

303 N William Kumpf Blvd
Peoria, IL 61605-2507

Mailing address

1112 Williamsburg Dr
Charleston, IL 61920-4335
Phone (217) 503-7065

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20221220000489 IL Practitioner - Physician Assistant 2668841313 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Osf Multi-Specialty GroupGroup PAC ID 3678889789, 2,123 clinicians

Practice addresses (Care Compare)

7800 N Sommer St
Peoria, IL 61615-1934
Phone (309) 676-5546

8600 State Route 91
Suite 130
Peoria, IL 61615-7829
Phone (309) 683-5050

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
085.009024ILMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Central PA Pharmacy LLC. Current Accepting new patients
Osf Multi-Specialty Group CurrentSince Oct 27, 2022 Accepting new patients

Locations

303 N William Kumpf Blvd
Peoria, IL 61605
Phone (309) 676-5546

8600 State Route 91
Ste 130
Peoria, IL 61615
Phone (309) 683-5050

420 NE Glen Oak Ave
Ste 301
Peoria, IL 61603
Phone (309) 655-7668

1420 W Pioneer Pkwy
Peoria, IL 61615
Phone (309) 308-5195

8600 State Route 91
Peoria, IL 61615
Phone (309) 683-5050

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1662508800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1662508800000",
    "number": "1033830195",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1112 WILLIAMSBURG DR",
            "city": "CHARLESTON",
            "state": "IL",
            "postal_code": "619204335",
            "telephone_number": "217-503-7065"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "303 N WILLIAM KUMPF BLVD",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616052507",
            "telephone_number": "309-676-5546",
            "fax_number": "309-676-5045"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUTTON",
        "first_name": "ABIGAIL",
        "middle_name": "ROSE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-09-07",
        "last_updated": "2022-09-07",
        "certification_date": "2022-09-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085.009024",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Peoria, IL

Sources for this page

Verify at the official NPI Registry.