NPIMap

Individual provider Active NPI

Jeremy Good, PA

  • Physician Assistant
  • Champaign, IL
National Provider Identifier
1104196294
Registry record updated Jan 15, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
085004264 Issued in IL
Practice address
3101 Fields South Dr
Champaign, IL 61822-3743
Phone
(217) 366-1240
NPI assigned
Jan 5, 2012
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 15, 2025

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 085004264 IL Primary

Addresses

Primary practice location

3101 Fields South Dr
Champaign, IL 61822-3743

Mailing address

101 W University Ave
Champaign, IL 61820-3981
Phone (217) 366-8107

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jgoodpa338585@CarleHieDirect.net Direct

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120126000353 IL Practitioner - Physician Assistant 5092982496 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Christie Clinic, PLLCGroup PAC ID 7719899319, 219 clinicians

Practice addresses (Care Compare)

101 W University Ave
Champaign, IL 61820-3909
Phone (217) 366-1200

108 Robinson St
Danville, IL 61832-8515
Phone (217) 442-8611

109 W University Ave
Champaign, IL 61820-3909
Phone (217) 366-5180

1120 N Melvin St
Gibson City, IL 60936-1477
Phone (217) 784-4251

1710 E Windsor Rd
Urbana, IL 61802-9564
Phone (217) 344-9440

209 W Borman Dr
Rantoul, IL 61866-3632
Phone (217) 893-9671

300 N Main St
Tuscola, IL 61953-1406
Phone (217) 253-9258

307 W Main St
Lexington, IL 61753-1327
Phone (309) 365-8608

Hospital & facility affiliations

  • St Joseph Medical Center Hospital, Bloomington, IL, CCN 140162
  • Carle Foundation Hospital Hospital, Urbana, IL, CCN 140091
  • Decatur Memorial Hospital Hospital, Decatur, IL, CCN 140135
  • Kirby Medical Center Hospital, Monticello, IL, CCN 141301
  • Gibson Community Hospital Hospital, Gibson City, IL, CCN 141317

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
085004264ILMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Methodist Medical Center of Illinois CurrentSince Jun 30, 2022 Accepting new patients
Christie Clinic, PLLC CurrentSince Nov 8, 2021 Accepting new patients
Siu Physicians & Surgeons, Inc CurrentSince Aug 3, 2020 Accepting new patients
Siu Physicians & Surgeons, Inc CurrentSince Aug 3, 2020 Accepting new patients
Board of Trustees of Southern Illinois University Current Accepting new patients
Methodist Medical Center of Illinois CurrentSince Jun 30, 2022 Accepting new patients
Gibson Community Hospital Association Past Accepting new patients

Locations

1776 Westlakes Pkwy
Ste 400
West Des Moines, IA 50266
Phone (515) 241-6161

2502 E Empire St
Bloomington, IL 61704
Phone (309) 662-6120

101 W University Ave
Champaign, IL 61820
Phone (217) 366-1255

3101 Fields South Dr
Champaign, IL 61822
Phone (217) 366-1237

108 Robinson St
Danville, IL 61832
Phone (217) 442-8611

302 W Hay St
Ste 200
Decatur, IL 62526
Phone (217) 876-3140

2300 N Edward St
Decatur, IL 62526
Phone (217) 876-3000

1120 N Melvin St
Gibson City, IL 60936
Phone (217) 355-1684

600 S 13th St
Pekin, IL 61554
Phone (309) 347-1151

112 NE Crescent Ave
Peoria, IL 61606
Phone (309) 680-2402

815 Main St
Ste A
Peoria, IL 61602
Phone (309) 672-4986

751 N Rutledge St
Springfield, IL 62702
Phone (217) 545-0182

Interoperability endpoints

  • Direct secure messaging: jeremygood@siusm.allscriptsdirect.net
  • Direct secure messaging: jgoodpa338585@carlehiedirect.net

Organizations & group practices 9

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 29

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

View all 29

NPI Registry JSON

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

{
    "created_epoch": "1325721600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736899200000",
    "number": "1104196294",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 W UNIVERSITY AVE",
            "city": "CHAMPAIGN",
            "state": "IL",
            "postal_code": "618203981",
            "telephone_number": "217-366-8107"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3101 FIELDS SOUTH DR",
            "city": "CHAMPAIGN",
            "state": "IL",
            "postal_code": "618223743",
            "telephone_number": "217-366-1240"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOOD",
        "first_name": "JEREMY",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-01-05",
        "last_updated": "2025-01-15",
        "certification_date": "2025-01-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085004264",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jgoodpa338585@CarleHieDirect.net",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "3101 Fields South Dr",
            "city": "Champaign",
            "state": "IL",
            "country_code": "US",
            "postal_code": "618223743",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Champaign, IL

Sources for this page

Verify at the official NPI Registry.