NPIMap

Individual provider Active NPI

James R Mangerson, PA-C

  • Physician Assistant
  • Peoria, IL
National Provider Identifier
1093078446
Registry record updated Jan 27, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
085010994 Issued in IL
Practice address
515 NE Glen Oak Ave Ste 202
Peoria, IL 61603-3166
Phone
(309) 624-4455
Fax
(309) 624-3457
NPI assigned
Jun 20, 2012
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 27, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 2956 WI
Physician Assistant 363A00000X 50.008880RX OH
Physician Assistant 363A00000X 085010994 IL Primary

Addresses

Primary practice location

515 NE Glen Oak Ave Ste 202
Peoria, IL 61603-3166

Mailing address

515 NE Glen Oak Ave Ste 202
Peoria, IL 61603-3166
Phone (309) 624-4455

Other practice location 1

721 American Ave
Suite 510
Waukesha, WI 53188-5071
Phone (262) 928-5300

Other practice location 2

3533 Southern Blvd Ste 5650
Kettering, OH 45429-1263
Phone (937) 294-3611

Electronic endpoints 2

TypeEndpointUseAffiliation
FHIR URL https:/khnarr.ketthealth.com/FHIR-PROD/api/FHIR/R4/
Direct Messaging Address jmangerson920169@direct.ketteringhealth.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI, OH, IL3 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20120821000668 WI Practitioner - Physician Assistant 5799932083 Reassigns benefits to 4 organizations
I20240815004600 OH Practitioner - Physician Assistant 5799932083 Reassigns benefits to 1 organization
I20250203000882 IL Practitioner - Physician Assistant 5799932083 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Prohealth Medical Group IncGroup PAC ID 3476465188, 475 clinicians
Aspirus Medical Group, Inc.Group PAC ID 1052223625, 272 clinicians
Osf Multi-Specialty GroupGroup PAC ID 3678889789, 2,123 clinicians

Practice addresses (Care Compare)

2750 Golf Rd
Delafield, WI 53018-2062
Phone (262) 928-4900

4005 Community Ctr Dr
Weston, WI 54476-4139
Phone (715) 241-5400

425 Pine Ridge Blvd
Wausau, WI 54401-4123

725 American Ave
Waukesha, WI 53188-5031
Phone (262) 928-1000

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

N17W24100 Riverwood Dr
Waukesha, WI 53188-1127
Phone (262) 928-4704

S69W15472 Janesville Rd
Muskego, WI 53150-9330
Phone (262) 928-7000

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2956WIMDAnesthesiology Physician
085010994ILMDPhysician Assistant
50.008880RXOHMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Aspirus Wausau Hospital, Inc. CurrentSince Aug 1, 2025 Accepting new patients
Central PA Pharmacy LLC. Current Accepting new patients
Aspirus Wausau Hospital, Inc. CurrentSince Aug 1, 2025 Accepting new patients
Aspirus Medical Group, Inc. CurrentSince Aug 1, 2025 Accepting new patients
Prohealth Medical Group Inc CurrentSince Oct 20, 2014 Accepting new patients
Osf Multi-Specialty Group CurrentSince Jan 27, 2025 Accepting new patients
Prohealth Medical Group Inc. CurrentSince Oct 20, 2014 Accepting new patients
Aspirus Medical Group, Inc. CurrentSince Aug 1, 2025 Accepting new patients
Prohealth Medical Group Inc Past Accepting new patients

Locations

29980 Network Pl
Chicago, IL 60673

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

515 NE Glen Oak Ave
Ste 202
Peoria, IL 61603
Phone (309) 624-4455

W168N11237 Western Ave
Germantown, WI 53022
Phone (262) 253-5060

721 American Ave
Ste 510
Waukesha, WI 53188
Phone (262) 521-2020

N14W23900 Stone Ridge Dr
Waukesha, WI 53188
Phone (262) 549-3030

725 American Ave
Waukesha, WI 53188
Phone (262) 544-2011

N17W24100 Riverwood Dr
Waukesha, WI 53188
Phone (262) 820-3093

333 Pine Ridge Blvd
Wausau, WI 54401
Phone (715) 847-2160

4005 Community Center Dr
Weston, WI 54476
Phone (715) 241-5400

Interoperability endpoints

  • Direct secure messaging: jmangerson380523@direct.aspirus.org

Organizations & group practices 12

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.

Hospital & facility affiliations 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1340150400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1737936000000",
    "number": "1093078446",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "515 NE GLEN OAK AVE STE 202",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616033166",
            "telephone_number": "309-624-4455",
            "fax_number": "309-624-3457"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "515 NE GLEN OAK AVE STE 202",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616033166",
            "telephone_number": "309-624-4455",
            "fax_number": "309-624-3457"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "721 American Ave",
            "address_2": "Suite 510",
            "address_purpose": "LOCATION",
            "city": "Waukesha",
            "state": "WI",
            "postal_code": "531885071",
            "country_code": "US",
            "telephone_number": "262-928-5300",
            "fax_number": "262-928-5301",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3533 Southern Blvd Ste 5650",
            "address_purpose": "LOCATION",
            "city": "Kettering",
            "state": "OH",
            "postal_code": "454291263",
            "country_code": "US",
            "telephone_number": "937-294-3611",
            "fax_number": "937-294-9010",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MANGERSON",
        "first_name": "JAMES",
        "middle_name": "R",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-06-20",
        "last_updated": "2025-01-27",
        "certification_date": "2025-01-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WI",
            "license": "2956",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OH",
            "license": "50.008880RX",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085010994",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https:/khnarr.ketthealth.com/FHIR-PROD/api/FHIR/R4/",
            "affiliation": "N",
            "address_1": "3533 Southern Blvd Ste 5650",
            "city": "Kettering",
            "state": "OH",
            "country_code": "US",
            "postal_code": "454291263",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jmangerson920169@direct.ketteringhealth.org",
            "affiliation": "N",
            "address_1": "3533 Southern Blvd Ste 5650",
            "city": "Kettering",
            "state": "OH",
            "country_code": "US",
            "postal_code": "454291263",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Peoria, IL

Sources for this page

Verify at the official NPI Registry.