Individual provider Active NPI

Tracy L Thompson, PA-C

  • Physician Assistant
  • Benton, IL
National Provider Identifier
1407616303
Registry record updated Apr 15, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
085010786 Issued in IL
Practice address
206 E Church St Ste B
Benton, IL 62812-2239
Phone
(618) 435-9888
NPI assigned
Mar 20, 2024
Last updated
Apr 15, 2026By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 15, 2026

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 085010786 IL Primary

Addresses

Primary practice location

206 E Church St Ste B
Benton, IL 62812-2239

Mailing address

PO Box 155
Christopher, IL 62822-0155
Phone (618) 724-2401

Other practice location 1

4230 Lincolnshire Dr Ste A
Mount Vernon, IL 62864-2189
Phone (618) 315-6466

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
I20250108002970 IL Practitioner - Physician Assistant 0244402899 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

206 E Church St
Suite B
Benton, IL 62812-2239
Phone (618) 435-9888

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
085010786ILMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Deaconess Illinois Specialty Clinic, Inc. CurrentSince Apr 14, 2025 Accepting new patients
Deaconess Illinois Specialty Clinic, Inc. Physician Assistant CurrentSince Apr 14, 2025 Accepting new patients
Advanced Urologic Surgeons PC PastSince Aug 25, 2016 Accepting new patients
Deaconess Illinois Clinic, Inc Past Accepting new patients
Heartland Occupational Medicine Physicians of Illinois S C PastSince Jan 24, 2011 Accepting new patients

Locations

303 S Commercial St
Harrisburg, IL 62946
Phone (618) 767-6050

2700 W Deyoung St
Marion, IL 62959
Phone (618) 969-8633

3111 Broadway St
Mount Vernon, IL 62864
Phone (618) 241-0300

818 E Broadway St
Sparta, IL 62286
Phone (618) 443-2177

509 Hamacher St
Waterloo, IL 62298
Phone (618) 939-3939

909 W Main St
West Frankfort, IL 62896
Phone (618) 372-6040

Interoperability endpoints

  • Direct secure messaging: ahujabariatricandbeyond.tracythompson@153356.advancedmd-direct.com

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

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": "1710892800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1776211200000",
    "number": "1407616303",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 155",
            "city": "CHRISTOPHER",
            "state": "IL",
            "postal_code": "628220155",
            "telephone_number": "618-724-2401",
            "fax_number": "618-724-4628"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "206 E CHURCH ST STE B",
            "city": "BENTON",
            "state": "IL",
            "postal_code": "628122239",
            "telephone_number": "618-435-9888"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4230 Lincolnshire Dr Ste A",
            "address_purpose": "LOCATION",
            "city": "Mount Vernon",
            "state": "IL",
            "postal_code": "628642189",
            "country_code": "US",
            "telephone_number": "618-315-6466",
            "fax_number": "866-755-6173",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "THOMPSON",
        "first_name": "TRACY",
        "middle_name": "L",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-03-20",
        "last_updated": "2026-04-15",
        "certification_date": "2026-04-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085010786",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Benton, IL

Sources for this page

Verify at the official NPI Registry.