Gerald Wayne McClallen, D.O.
Individual provider Active NPI Emergency Medicine Physician · Murphysboro, IL
NPI 1285686709 · NPPES record last updated Sep 27, 2021
Key facts
- NPI
- 1285686709
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Emergency Medicine Physician 207P00000X
- License
- 036-078422 (IL)
- Practice address
- 2 S Hospital Dr
Murphysboro, IL 62966-3333 - Phone
- (618) 684-3156
- Fax
- (618) 529-0524
- NPI assigned
- May 16, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Hospital & facility affiliations 6
Medicare Care Compare profile
- Specialty
- Emergency Medicine
- Education
- At Still University of Health Sciences, College of Osteo Med, Kirksville, 1984
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Eldorado Emergency Group PC
Practice addresses (Care Compare)
1201 Pine St
Eldorado, IL 62930-1634
Phone (618) 273-3361
Hospital & facility affiliations
- Ferrell Hospital Community Foundations
Merit-based Incentive Payment System (MIPS)
- Final score
- 98.25 of 100
- Quality
- 100
- Improvement activities
- 40
- Cost
- 73.66
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20040415000359 | IL | Practitioner - Emergency Medicine | 2769477256 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036-078422 | IL | MD | Emergency Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Eldorado Emergency Group PC | Emergency Medicine | Current |
Accepting new patients |
| Southern Illinois Medical Services, NFP | Current |
Accepting new patients |
Locations
201 Bailey Ln
Benton, IL 62812
Phone (618) 438-3113
405 W Jackson St
Carbondale, IL 62901
1239 E Main St
Carbondale, IL 62901
2601 W Main St
Carbondale, IL 62901
Phone (618) 351-7300
1201 Pine St
Eldorado, IL 62930
Phone (618) 273-3361
201 S 14th St
Herrin, IL 62948
Phone (618) 942-2171
2 S Hospital Dr
Murphysboro, IL 62966
Phone (618) 684-3156
200 Corporate Blvd
Lafayette, LA 70508
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | 036-078422 | IL | Yes |
Addresses
Primary practice location
2 S Hospital Dr
Murphysboro, IL 62966-3333
Mailing address
PO Box 3988
Carbondale, IL 62902-3988
Phone (800) 457-5200
Other practice location 1
405 W Jackson St
Carbondale, IL 62901-1462
Phone (618) 549-0721
Other practice location 2
201 S 14th St
Herrin, IL 62948-3631
Phone (618) 942-2171
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 046749 | Other | HEALTH ALLIANCE |
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | gmcclallen14217@sih.direct-ci.com | ||
| Direct Messaging Address | gmcclallen14217@sih.direct-ci.com | ||
| Direct Messaging Address | gmcclallen14217@sih.direct-ci.com |
Other providers in Murphysboro, IL
- Marion County Horizon Center D/B/a Our Place
- Marion Eye Centers LTD.
- Rheaven Martin
- Shanie Breann May
- Cheryl McCann
- Alexandria Monique McCloud
- Jana Lynn McDaniel
- Jonathan T Mears
- Medical Arts Clinic LTD
- Katherine Maxine Meekins
All providers in Murphysboro, IL · Emergency Medicine Physician in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 27, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.