NPIMap

Individual provider Active NPI

Erin Elizabeth Fancher Gagen, MD

  • Family Medicine Physician
  • Trenton, IL
National Provider Identifier
1184657090
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
036113295 Issued in IL
Practice address
411 E Broadway
Trenton, IL 62293-1663
Phone
(618) 224-7000
Fax
(618) 224-7750
NPI assigned
Jul 7, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 036113295 IL Primary

Addresses

Primary practice location

411 E Broadway
Trenton, IL 62293-1663

Mailing address

411 E Broadway
Trenton, IL 62293-1663
Phone (618) 224-7000

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
I20050712000773 IL Practitioner - Family Practice 7810923794 Receives reassigned benefits from 1 practitioner
Practice locations: Trenton, IL

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Illinois College of Med (CHI/Peor/Rock/CHM-Urb), 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

411 E Broadway
Trenton, IL 62293-1663
Phone (618) 224-7000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
94.81 of 100Reported as apm
Quality
85.98
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Clinton Manor Living CenterNew Baden, IL, CCN 146025 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Apr 1, 2016
Apr 1, 2016

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Hospital & facility affiliations 10

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": "1152230400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1184657090",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "411 E BROADWAY",
            "city": "TRENTON",
            "state": "IL",
            "postal_code": "622931663",
            "telephone_number": "618-224-7000",
            "fax_number": "618-224-7750"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "411 E BROADWAY",
            "city": "TRENTON",
            "state": "IL",
            "postal_code": "622931663",
            "telephone_number": "618-224-7000",
            "fax_number": "618-224-7750"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FANCHER GAGEN",
        "first_name": "ERIN",
        "middle_name": "ELIZABETH",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-07-07",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036113295",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Trenton, IL

Sources for this page

Verify at the official NPI Registry.