Jessica Leigh Gibson, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

085.004962 Issued in IL

Practice address

2704 N Center St
Maryville, IL 62062-5624

Phone

(270) 556-8641

NPI assigned

Jan 7, 2014

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL, AZ2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Specialty

Physician Assistant

Education

Other, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Banner Urgent Care Services LLC 207 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• Banner Urgent Care Services, LLC

  • Urgent Care Clinic/Center
  • Scottsdale, AZ
  • NPI 1609229764

  AZ

  Medicare reassignment Care Compare group
• Emergency Services Midwest SC

  • Emergency Medicine Physician
  • Belleville, IL
  • NPI 1174024806

  IL

  Medicare reassignment
• Banner Urgent Care Arizona LLC

  • Urgent Care Clinic/Center
  • Casa Grande, AZ
  • NPI 1316349855

  AZ

  Medicare reassignment
• Banner Urgent Care Arizona LLC

  • Urgent Care Clinic/Center
  • Payson, AZ
  • NPI 1194369074
  NPD
• Banner Urgent Care Services, LLC

  • Urgent Care Clinic/Center
  • San Tan Valley, AZ
  • NPI 1942653019
  NPD
• Banner Urgent Care Services, LLC

  • Urgent Care Clinic/Center
  • Tucson, AZ
  • NPI 1962855031
  NPD
• Anderson Medical Group, LLC

  • General Practice Physician
  • Maryville, IL
  • NPI 1700807716
  NPD (past)

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

{
    "created_epoch": "1389052800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1389052800000",
    "number": "1164844387",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2704 N CENTER ST",
            "city": "MARYVILLE",
            "state": "IL",
            "postal_code": "620625624",
            "telephone_number": "270-556-8641"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2704 N CENTER ST",
            "city": "MARYVILLE",
            "state": "IL",
            "postal_code": "620625624",
            "telephone_number": "270-556-8641"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GIBSON",
        "first_name": "JESSICA",
        "middle_name": "LEIGH",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-01-07",
        "last_updated": "2014-01-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085.004962",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rachel Nicole Gaudreault, PA-C
• Kelly Jester Geldmacher, M.D.
• General and Vascular Surgical Assoc
• Genoa Healthcare LLC
• Anna Joy Gerlach, LPC
• Nathan John Gibson, PT
• Aaliyah Gladney, AUD
• Terry Glenn
• Cameron Gordineer, DC
• Marie Graham

• All providers in Maryville, IL
• Physician Assistant in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.