Individual provider Active NPI

John Thomas Davis, MD

  • Orthopaedic Surgery Physician
  • Herrin, IL
National Provider Identifier
1063436756
Registry record updated May 21, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
License
036115943 Issued in IL
Practice address
510 Lincoln Drive
Herrin, IL 62948
Phone
(618) 997-6800
Fax
(618) 997-1187
NPI assigned
Jul 26, 2006
Last updated
May 21, 2015By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 21, 2015

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X 036-115943 IL
Orthopaedic Surgery Physician 207X00000X 036115943 IL Primary

Addresses

Primary practice location

510 Lincoln Drive
Herrin, IL 62948

Mailing address

510 Lincoln Drive
Herrin, IL 62948
Phone (618) 997-6800

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060818000426 IL Practitioner - Orthopedic Surgery 0244233948 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Orthopedic Surgery
Education
Tulane University School of Medicine, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Select Physical Therapy Holdings IncGroup PAC ID 9537076401, shared by 76 NPIs, 1,992 clinicians
Southern Orthopedic Associates SCGroup PAC ID 8921095514, 29 clinicians

Practice addresses (Care Compare)

1104 W Main St
Benton, IL 62812-1565
Phone (618) 439-3399

510 Lincoln Dr
Herrin, IL 62948-3774

510 Lincoln Dr
Herrin, IL 62948-6334
Phone (618) 997-6800

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
89.56 of 100Reported as group
Quality
83.23
Promoting interoperability
100
Improvement activities
40
Cost
75.4

Procedures performed for Medicare patients

ProcedureNumber of procedures
Lower limb (leg) arthroscopy (minimally invasive joint repair)22
Upper limb (arm) arthroscopy (minimally invasive joint repair)16

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
036-115943ILMDSpecialist
036115943ILMDOrthopaedic Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Southern Orthopedic Associates SC Orthopaedic Surgery CurrentSince Aug 21, 2006 Accepting new patients

Locations

510 Lincoln Dr
Herrin, IL 62948
Phone (618) 997-3100

Interoperability endpoints

  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
  • Direct secure messaging: jdavi413@yourcarecommunity.org
  • Direct secure messaging: jdavis420499@direct.deaconess.com

Organizations & group practices 1

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

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1153872000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1432166400000",
    "number": "1063436756",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "510 LINCOLN DRIVE",
            "city": "HERRIN",
            "state": "IL",
            "postal_code": "62948",
            "telephone_number": "618-997-6800",
            "fax_number": "618-997-1187"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "510 LINCOLN DRIVE",
            "city": "HERRIN",
            "state": "IL",
            "postal_code": "62948",
            "telephone_number": "618-997-6800",
            "fax_number": "618-997-1187"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "JOHN",
        "middle_name": "THOMAS",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-26",
        "last_updated": "2015-05-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "IL",
            "license": "036-115943",
            "primary": false
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "IL",
            "license": "036115943",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Herrin, IL

Sources for this page

Verify at the official NPI Registry.