NPIMap

Organization Active NPI

Gibson Community Hosptial Assn

Doing business as Prairie Family Medicine and Obstetrics

  • Physician Assistant
  • Forrest, IL
National Provider Identifier
1154723492
Registry record updated Sep 18, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
085005214 Issued in IL
Legal business name
GIBSON COMMUNITY HOSPTIAL ASSN
Doing business as
Prairie Family Medicine and Obstetrics
Practice address
122 E Wabash Ave
Forrest, IL 61741-9369
Phone
(815) 657-8707
Fax
(815) 657-8717
NPI assigned
Sep 18, 2014
Last updated
Sep 18, 2014By the provider in NPPES
Organization subpart
Yes
Parent organization
GIBSON COMMUNITY HOSPITAL ASSNAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 18, 2014

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

Authorized official

Name
Dawn R Kestner, CPC
Title
Office Manager
Phone
(815) 657-8707

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 085005214 IL Primary

Addresses

Primary practice location

122 E Wabash Ave
Forrest, IL 61741-9369

Mailing address

122 E Wabash Ave
P O Box 58
Forrest, IL 61741-9369
Phone (815) 657-8707

Other identifiers 1

IdentifierTypeStateIssuer
1063462976MedicaidIL

Other names 1

  • Prairie Family Medicine and Obstetrics Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Gibson Area Hospital43 organizations share this tax ID, including this one
Part of
Gibson Area Hospital

Other organizations with this tax ID 42

Organizations that report the same tax identification number in the National Provider Directory.

View all 42

Locations

122 E Wabash Ave
Forrest, IL 61741
Phone (815) 579-9002

NPI Registry JSON

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

{
    "created_epoch": "1410998400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1410998400000",
    "number": "1154723492",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "122 E WABASH AVE",
            "address_2": "P O BOX 58",
            "city": "FORREST",
            "state": "IL",
            "postal_code": "617419369",
            "telephone_number": "815-657-8707",
            "fax_number": "815-657-8717"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "122 E WABASH AVE",
            "city": "FORREST",
            "state": "IL",
            "postal_code": "617419369",
            "telephone_number": "815-657-8707",
            "fax_number": "815-657-8717"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GIBSON COMMUNITY HOSPTIAL ASSN",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GIBSON COMMUNITY HOSPITAL ASSN",
        "enumeration_date": "2014-09-18",
        "last_updated": "2014-09-18",
        "status": "A",
        "authorized_official_last_name": "KESTNER",
        "authorized_official_first_name": "DAWN",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "815-657-8707",
        "authorized_official_credential": "CPC"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085005214",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1063462976",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Prairie Family Medicine and Obstetrics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Forrest, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.