Active NPI
Leesa E Gillooley, PA-C
- Physician Assistant
- Rockford, IL
National Provider Identifier
1154567964
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 085003368
- Practice address
- 698 Featherstone Rd
Rockford, IL 61107-6303 - Phone
- (815) 398-3277
- NPI assigned
- Dec 29, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 085003368 | IL | Primary |
Addresses
Primary practice location
698 Featherstone Rd
Rockford, IL 61107-6303
Mailing address
698 Featherstone Rd
Rockford, IL 61107-6303
Phone (815) 398-3277
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 085003368 | IL | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1230508800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1276473600000",
"number": "1154567964",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "698 FEATHERSTONE RD",
"city": "ROCKFORD",
"state": "IL",
"postal_code": "611076303",
"telephone_number": "815-398-3277"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "698 FEATHERSTONE RD",
"city": "ROCKFORD",
"state": "IL",
"postal_code": "611076303",
"telephone_number": "815-398-3277"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GILLOOLEY",
"first_name": "LEESA",
"middle_name": "E",
"name_prefix": "Mrs.",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-12-29",
"last_updated": "2010-06-14",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "IL",
"license": "085003368",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rockford, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.