Active NPI
Joey Alan Wegmann, PA-C
- Surgical Physician Assistant
- Mount Vernon, IL
National Provider Identifier
1376656827
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgical Physician Assistant
- License
- 085000851
- Practice address
- 302 Broadway St
Mount Vernon, IL 62864-5116 - Phone
- (618) 242-4750
- Fax
- (618) 242-7674
- NPI assigned
- Aug 17, 2006
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Surgical Physician Assistant | 363AS0400X | 085000851 | IL | Primary |
Addresses
Primary practice location
302 Broadway St
Mount Vernon, IL 62864-5116
Mailing address
1700 N. Henderson
Osf Galesburg Clinic Prompt Care
Galesburg, IL 61401
Phone (309) 343-1000
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 085000851 | Medicaid | IL | |
| 719926 | Other | IL | HEALTHLINK |
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155772800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1360195200000",
"number": "1376656827",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1700 N. HENDERSON",
"address_2": "OSF GALESBURG CLINIC PROMPT CARE",
"city": "GALESBURG",
"state": "IL",
"postal_code": "61401",
"telephone_number": "309-343-1000",
"fax_number": "309-343-5207"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "302 BROADWAY ST",
"city": "MOUNT VERNON",
"state": "IL",
"postal_code": "628645116",
"telephone_number": "618-242-4750",
"fax_number": "618-242-7674"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WEGMANN",
"first_name": "JOEY",
"middle_name": "ALAN",
"name_prefix": "Mr.",
"credential": "PA-C",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-08-17",
"last_updated": "2013-02-07",
"status": "A"
},
"taxonomies": [
{
"code": "363AS0400X",
"taxonomy_group": "",
"desc": "Physician Assistant, Surgical",
"state": "IL",
"license": "085000851",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "085000851",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTHLINK",
"identifier": "719926",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Mount Vernon, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.