Individual provider Active NPI

James G Coleman, PA-C

  • Physician Assistant
  • Carlyle, IL
National Provider Identifier
1194076208
Registry record updated Sep 28, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
085004470 Issued in IL
Practice address
18209 Eula Mae Pkwy
Carlyle, IL 62231-6407
Phone
(618) 594-3671
Fax
(618) 594-8058
NPI assigned
Sep 28, 2012
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 28, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 085004470 IL Primary

Addresses

Primary practice location

18209 Eula Mae Pkwy
Carlyle, IL 62231-6407

Mailing address

2717 Piper Hills Dr
Belleville, IL 62221-3457
Phone (618) 593-3764

Other identifiers 1

IdentifierTypeStateIssuer
085004470OtherILILLINOIS STATE LICENSE NUMBER

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
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 1

Enrollment IDStateProvider typePAC IDDetails
I20121025000274 IL Practitioner - Physician Assistant 1557511680 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Southern Illinois University School of Medicine, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Vituity - Illinois Auc LLPGroup PAC ID 0547516932, 35 clinicians

Practice addresses (Care Compare)

1512 N Green Mount Rd
O Fallon, IL 62269-2083
Phone (618) 624-3750

801 W Temple Ave
Effingham, IL 62401-2168
Phone (217) 347-1690

Hospital & facility affiliations

  • HSHS St Elizabeth'S Hospital Hospital, O Fallon, IL, CCN 140187
  • Osf Saint Anthony'S Health Center Hospital, Alton, IL, CCN 140052

Merit-based Incentive Payment System (MIPS)

Final score
93.41 of 100Reported as group
Quality
86.81
Improvement activities
40
Cost
77.34

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Quality
95
Improvement activities
40
Cost
80.65

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Cepamerica Illinois LLP CurrentSince Feb 1, 2013 Accepting new patients
Vituity - Illinois Auc LLP CurrentSince Jun 1, 2018 Accepting new patients
Cepamerica Illinois LLP CurrentSince Feb 1, 2013 Accepting new patients

Locations

1601 Cummins Dr
Ste D
Modesto, CA 95358
Phone (510) 851-7423

600 S Randall Rd
Algonquin, IL 60102
Phone (224) 783-4300

3249 Oak Park Ave
Berwyn, IL 60402
Phone (708) 783-2696

900 W Temple Ave
Bldg B
Effingham, IL 62401
Phone (217) 347-1690

801 W Temple Ave
Effingham, IL 62401
Phone (217) 342-5800

1425 N Randall Rd
Elgin, IL 60123
Phone (224) 783-5437

12866 Troxler Ave
Highland, IL 62249
Phone (618) 651-2600

1512 N Green Mount Rd
O Fallon, IL 62269
Phone (618) 624-0100

1 Saint Elizabeth Blvd
O Fallon, IL 62269
Phone 618234212012438

Organizations & group practices 6

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.

Hospital & facility affiliations 2

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": "1348790400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1348790400000",
    "number": "1194076208",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2717 PIPER HILLS DR",
            "city": "BELLEVILLE",
            "state": "IL",
            "postal_code": "622213457",
            "telephone_number": "618-593-3764"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18209 EULA MAE PKWY",
            "city": "CARLYLE",
            "state": "IL",
            "postal_code": "622316407",
            "telephone_number": "618-594-3671",
            "fax_number": "618-594-8058"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COLEMAN",
        "first_name": "JAMES",
        "middle_name": "G",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-09-28",
        "last_updated": "2012-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085004470",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ILLINOIS STATE LICENSE NUMBER",
            "identifier": "085004470",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Carlyle, IL

Sources for this page

Verify at the official NPI Registry.