Active NPI
Tammy Kay Munch, PA-C
- Physician Assistant
- Decatur, IL
National Provider Identifier
1285713768
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 085.002873
- Practice address
- 102 W Kenwood Ave
Suite 110
Decatur, IL 62526-4368 - Phone
- (217) 876-6880
- NPI assigned
- Nov 3, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 085.002873 | IL | Primary |
Addresses
Primary practice location
102 W Kenwood Ave
Suite 110
Decatur, IL 62526-4368
Mailing address
7 Hawthorne Lane
SBL Sullivan Clinic
Sullivan, IL 61951
Phone (217) 728-8441
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 085.002873 | IL | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162512000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1238025600000",
"number": "1285713768",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7 HAWTHORNE LANE",
"address_2": "SBL SULLIVAN CLINIC",
"city": "SULLIVAN",
"state": "IL",
"postal_code": "61951",
"telephone_number": "217-728-8441",
"fax_number": "217-728-8678"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "102 W KENWOOD AVE",
"address_2": "SUITE 110",
"city": "DECATUR",
"state": "IL",
"postal_code": "625264368",
"telephone_number": "217-876-6880"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MUNCH",
"first_name": "TAMMY",
"middle_name": "KAY",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-11-03",
"last_updated": "2009-03-26",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "IL",
"license": "085.002873",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Decatur, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.