NPIMap

Individual provider Active NPI

David John Hagan, MD

  • Family Medicine Physician
  • Gibson City, IL
National Provider Identifier
1467433557
Registry record updated Aug 11, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
036066538 Issued in IL
Practice address
222 N Sangamon Ave
Gibson City, IL 60936-1345
Phone
(217) 784-8148
Fax
(217) 784-8160
NPI assigned
Nov 7, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 11, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 036066538 IL Primary

Addresses

Primary practice location

222 N Sangamon Ave
Gibson City, IL 60936-1345

Mailing address

1120 N Melvin St
Gibson City, IL 60936-1477
Phone (217) 784-8148

Other identifiers 2

IdentifierTypeStateIssuer
2715526OtherBCBS
143882OtherRIVERBEND MEDICARE

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address david.hagan.p4@direct.gapho.nextgenshare.com Direct

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
I20101021000871 IL Practitioner - Family Practice 6002967262 Reassigns benefits to 2 organizations

All facility ownership & control disclosures 7

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Prairie Family Medicine & ObstetricsForrest, IL, CCN 148505 Rural health clinic Corporate Director Nov 1, 1985
The Onarga ClinicOnarga, IL, CCN 143440 Rural health clinic Corporate Director
W-2 Managing Employee		 Nov 1, 1985
Jun 1, 2016
The Paxton ClinicPaxton, IL, CCN 143408 Rural health clinic Corporate Director Nov 1, 1985
Family Health Clinic of Farmer CityFarmer City, IL, CCN 148517 Rural health clinic Corporate Director
W-2 Managing Employee		 Nov 1, 1985
Jun 1, 2016
Gibson Area Primary CareGibson City, IL, CCN 148516 Rural health clinic Corporate Director Nov 1, 1985
Family Healthcare of HoopestonHoopeston, IL, CCN 148515 Rural health clinic Corporate Director
W-2 Managing Employee		 Nov 1, 1985
Jun 1, 2016
Gibson City ClinicGibson City, IL, CCN 148559 Rural health clinic Corporate Director Nov 1, 1985

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036066538ILMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Gibson Community Hospital Association Current Accepting new patients
Gibson Community Hospital Association CurrentSince Nov 1, 1985 Accepting new patients
Gibson Community Hospital Association Current Accepting new patients
Gibson Community Hospital Association CurrentSince Jun 1, 2016 Accepting new patients

Locations

7 Doctors Park
Gibson City, IL 60936
Phone (217) 784-5500

1120 N Melvin St
Gibson City, IL 60936
Phone (217) 355-1684

222 N Sangamon Ave
Gibson City, IL 60936
Phone (217) 748-8148

227 N Market St
Paxton, IL 60957
Phone (217) 379-4864

Interoperability endpoints

  • Direct secure messaging: david.hagan.p4@direct.gapho.nextgenshare.com

Organizations & group practices 18

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.

View all 18

Hospital & facility affiliations 23

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 23

Owned or controlled facilities with NPI records 8

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1980
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Gibson Community Hospital Association 159 clinicians

Practice addresses (Care Compare)

227 N Market St
Paxton, IL 60957-1123
Phone (217) 379-4864

Hospital & facility affiliations

  • Gibson Community Hospital Hospital, Gibson City, IL, CCN 141317
  • Gibson Community HSP Annex Nursing home, Gibson City, IL, CCN 145979

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1131321600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1597104000000",
    "number": "1467433557",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1120 N MELVIN ST",
            "city": "GIBSON CITY",
            "state": "IL",
            "postal_code": "609361477",
            "telephone_number": "217-784-8148"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "222 N SANGAMON AVE",
            "city": "GIBSON CITY",
            "state": "IL",
            "postal_code": "609361345",
            "telephone_number": "217-784-8148",
            "fax_number": "217-784-8160"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAGAN",
        "first_name": "DAVID",
        "middle_name": "JOHN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-07",
        "last_updated": "2020-08-11",
        "certification_date": "2020-08-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036066538",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "2715526",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RIVERBEND MEDICARE",
            "identifier": "143882",
            "state": null
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "david.hagan.p4@direct.gapho.nextgenshare.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "222 N Sangamon Ave",
            "city": "Gibson City",
            "state": "IL",
            "country_code": "US",
            "postal_code": "609361345",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Gibson City, IL

Sources for this page

Verify at the official NPI Registry.