NPIMap

Individual provider Active NPI

Caitlyn Clare Wagenbach, PA-C

  • Physician Assistant
  • Peoria Heights, IL
National Provider Identifier
1346856846
Registry record updated Oct 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
4616 N Prospect Rd
Peoria Heights, IL 61616-6460
Phone
(217) 528-7541
NPI assigned
Sep 20, 2020
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 22, 2024

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 Primary

Addresses

Primary practice location

4616 N Prospect Rd
Peoria Heights, IL 61616-6460

Mailing address

PO Box 19248
Springfield, IL 62794-9248
Phone (217) 528-7541

Other names 1

  • Caitlyn Clare Honan Former name

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
I20220727002651 IL Practitioner - Physician Assistant 0840672531 Reassigns benefits to 7 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Springfield Clinic, LLPGroup PAC ID 0547166076, 678 clinicians

Practice addresses (Care Compare)

4616 N Prospect Rd
Peoria, IL 61616-6460
Phone (309) 495-0050

775 Engineering Ave
Springfield, IL 62703-5909
Phone (217) 522-4300

Hospital & facility affiliations

  • Saint Francis Medical Center Hospital, Peoria, IL, CCN 140067
  • Carle Health Methodist Hospital Hospital, Peoria, IL, CCN 140209
  • Carle Health Proctor Hospital Hospital, Peoria, IL, CCN 140013
  • Memorial Medical Center Hospital, Springfield, IL, CCN 140148

Merit-based Incentive Payment System (MIPS)

Final score
88.83 of 100Reported as apm
Quality
75.65
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Springfield Clinic, LLP CurrentSince Sep 1, 2024 Accepting new patients
Carle Health Care Incorporated CurrentSince Jan 1, 2026 Accepting new patients
Methodist Medical Center of Illinois CurrentSince Dec 1, 2024 Accepting new patients

Locations

600 S 13th St
Pekin, IL 61554
Phone (309) 347-1151

112 NE Crescent Ave
Peoria, IL 61606
Phone (309) 680-2402

221 NE Glen Oak Ave
Peoria, IL 61636
Phone (309) 672-4281

5409 N Knoxville Ave
Peoria, IL 61614
Phone (309) 691-1000

4616 N Prospect Rd
Peoria Heights, IL 61616
Phone (309) 495-0050

775 Engineering Ave
Springfield, IL 62703
Phone (217) 522-4300

611 W Park St
Urbana, IL 61801
Phone (217) 383-6941

Interoperability endpoints

  • Direct secure messaging: caitlyn.wagenbach.1@28977.direct.athenahealth.com

Organizations & group practices 8

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 4

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": "1600560000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729555200000",
    "number": "1346856846",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 19248",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627949248",
            "telephone_number": "217-528-7541"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4616 N PROSPECT RD",
            "city": "PEORIA HEIGHTS",
            "state": "IL",
            "postal_code": "616166460",
            "telephone_number": "217-528-7541"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGENBACH",
        "first_name": "CAITLYN",
        "middle_name": "CLARE",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-09-20",
        "last_updated": "2024-10-22",
        "certification_date": "2024-10-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CAITLYN",
            "last_name": "HONAN",
            "middle_name": "CLARE",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Peoria Heights, IL

Sources for this page

Verify at the official NPI Registry.