NPIMap

Individual provider Active NPI

Gautam Jha, MD

  • Internal Medicine Physician
  • Effingham, IL
National Provider Identifier
1447314737
Registry record updated Oct 9, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
036096423 Issued in IL
Practice address
1901 S 4TH St Ste 30
Effingham, IL 62401-4162
Phone
(877) 275-3754
NPI assigned
Dec 20, 2006
Last updated
Oct 9, 2026By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 9, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 036096423 IL Primary

Addresses

Primary practice location

1901 S 4TH St Ste 30
Effingham, IL 62401-4162

Mailing address

1901 S 4TH St Ste 30
Effingham, IL 62401-4162
Phone (877) 275-3754

Other identifiers 1

IdentifierTypeStateIssuer
036096423MedicaidIL

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
I20101230000850 IL Practitioner - Internal Medicine 3173711447 Reassigns benefits to 4 organizations
Practice locations: Centralia, IL; Salem, IL

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Salem Township HospitalGroup PAC ID 0840195277, 26 clinicians
Amky Mso-1 PLLCGroup PAC ID 0446777114, 2 clinicians

Practice addresses (Care Compare)

1201 Ricker Rd
Salem, IL 62881-4263

1325 W Whittaker St
Suite D
Salem, IL 62881-2034
Phone (618) 740-0300

400 N Pleasant Ave
Centralia, IL 62801-3056
Phone (618) 436-8000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
20.59 of 100Reported as individual
Quality
0
Improvement activities
0
Cost
68.63

Merit-based Incentive Payment System (MIPS)

Final score
88.96 of 100Reported as apm
Quality
69.5
Promoting interoperability
100
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Quality
92.55
Promoting interoperability
100
Improvement activities
40
Cost
79.49

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
036096423ILMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Good Samaritan Regional Health Center CurrentSince Dec 28, 2025 Accepting new patients
St. Mary's Hospital, Centralia, Illinois CurrentSince Nov 10, 2018 Accepting new patients
St. Mary's Hospital, Centralia, Illinois CurrentSince Nov 10, 2018 Accepting new patients
Amky Mso-1 PLLC Internal Medicine CurrentSince Dec 15, 2025 Accepting new patients
Salem Township Hospital Past Accepting new patients

Locations

400 N Pleasant Ave
Centralia, IL 62801
Phone (618) 436-5221

7420 Solutions Ctr
Chicago, IL 60677
Phone (314) 989-3155

1 Good Samaritan Way
Mount Vernon, IL 62864
Phone (618) 242-4600

5 Good Samaritan Way
Mount Vernon, IL 62864
Phone (557) 203-1601

605 N 12th St
Mount Vernon, IL 62864
Phone (618) 241-2200

1250 W Whittaker St
Salem, IL 62881
Phone (618) 548-3740

1325 W Whittaker St
Ste D
Salem, IL 62881
Phone (215) 684-9999

1145 Corporate Lake Dr
Saint Louis, MO 63132
Phone (314) 989-6189

Interoperability endpoints

  • Direct secure messaging: amkymso.gautamjha@160088.advancedmd-direct.com
  • Direct secure messaging: gjha81990@direct-ehr-ssmhc.com
  • FHIR API: https://api.platform.athenahealth.com/13311/brand/1/csg/1/fhir/r4
  • FHIR API: https://ssproxy.osfhealthcare.org/fhir-proxy/api/FHIR/R4

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 9

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": "1166572800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1791504000000",
    "number": "1447314737",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1901 S 4TH ST STE 30",
            "city": "EFFINGHAM",
            "state": "IL",
            "postal_code": "624014162",
            "telephone_number": "877-275-3754"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1901 S 4TH ST STE 30",
            "city": "EFFINGHAM",
            "state": "IL",
            "postal_code": "624014162",
            "telephone_number": "877-275-3754"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JHA",
        "first_name": "GAUTAM",
        "name_prefix": "Mr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-12-20",
        "last_updated": "2026-10-09",
        "certification_date": "2026-10-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036096423",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036096423",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Effingham, IL

Sources for this page

Verify at the official NPI Registry.