NPIMap

Individual provider Active NPI

Jeffery S Deacon, DPM

  • Podiatrist
  • Marion, IL
National Provider Identifier
1104919075
Registry record updated Apr 16, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
License
016004769 Issued in IL
Practice address
3403 Professional Park Dr
Marion, IL 62959-6394
Phone
(618) 993-0333
Fax
(618) 993-0545
NPI assigned
Oct 2, 2006
Last updated
Apr 16, 2008By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 16, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Podiatrist 213E00000X 016004769 IL Primary

Addresses

Primary practice location

3403 Professional Park Dr
Marion, IL 62959-6394

Mailing address

3403 Professional Park Dr
Marion, IL 62959-6394
Phone (618) 993-0333

Other identifiers 1

IdentifierTypeStateIssuer
016004769001MedicaidIL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL2 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 2

Enrollment IDStateProvider typePAC IDDetails
I20061221000132 IL Practitioner - Podiatry 3274504832 Reassigns benefits to 1 organization
Practice locations: Marion, IL
O20100930055112 IL DME Supplier - Physician - Podiatry 2264553080 Practice locations: Marion, IL

Care Compare profile

Medicare Care Compare
Specialty
Podiatry
Education
William M. Scholl College of Podiatric Medicine, 1993
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

Practice addresses (Care Compare)

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

3403 Professional Park Dr
Marion, IL 62959-6394
Phone (618) 993-0333

517 N Main St
RM 22
Anna, IL 62906-1668
Phone (618) 833-2295

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue41
Removal of nail tissue239
Removal or shaving of skin growth61

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Deaconess Illinois Union County Hospital Inc Podiatrist CurrentSince Jan 14, 2023 Accepting new patients
Deaconess Union County Hospital, Inc PastSince Jan 14, 2023 Accepting new patients
Deaconess Illinois Union County Hospital Inc Past Accepting new patients

Locations

515 N Main St
Ste D
Anna, IL 62906
Phone (618) 833-2872

515 N Main St
Ste E
Anna, IL 62906
Phone (618) 833-2414

517 N Main St
Anna, IL 62906
Phone (618) 833-2295

517 N Main St
Rm 22
Anna, IL 62906
Phone (618) 833-2295

Interoperability endpoints

  • Direct secure messaging: deaconj@yourcarecommunity.org
  • Direct secure messaging: jeffery.deacon.1@19485.direct.athenahealth.com
  • Direct secure messaging: jeffery.deacon.1@27782.direct.athenahealth.com

Organizations & group practices 3

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 4

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": "1159747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1208304000000",
    "number": "1104919075",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3403 PROFESSIONAL PARK DR",
            "city": "MARION",
            "state": "IL",
            "postal_code": "629596394",
            "telephone_number": "618-993-0333",
            "fax_number": "618-993-0545"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3403 PROFESSIONAL PARK DR",
            "city": "MARION",
            "state": "IL",
            "postal_code": "629596394",
            "telephone_number": "618-993-0333",
            "fax_number": "618-993-0545"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEACON",
        "first_name": "JEFFERY",
        "middle_name": "S",
        "name_prefix": "Dr.",
        "credential": "DPM",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-02",
        "last_updated": "2008-04-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "IL",
            "license": "016004769",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "016004769001",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Marion, IL

Sources for this page

Verify at the official NPI Registry.