Carolyn Jean Gale, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

085001195 Issued in IL

Practice address

101 N Main St
Walnut, IL 61376

Phone

(815) 379-2020

Fax

(815) 379-2018

NPI assigned

Oct 5, 2007

Last updated

Oct 15, 2020By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other names 1

• Carolyn Jean Shadoin Other name

Electronic endpoints 2

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

Specialty

Physician Assistant

Education

Other, 1996

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Osf Healthcare SystemGroup PAC ID 4284541806, 94 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Osf Healthcare Home Care Home health agency, Loves Park, IL, CCN 147271
• In-Home Care Connection Home Health Services Home health agency, Moline, IL, CCN 148146
• Osf Saint Clare Medical Center Hospital, Princeton, IL, CCN 141337
• Osf Saint Elizabeth MDL Ctr Hospital, Peru, IL, CCN 140110
• Saint Francis Medical Center Hospital, Peoria, IL, CCN 140067
• Osf Saint Katharine Medical Center Hospital, Dixon, IL, CCN 140012
• Osf Saint Paul Medical Center Hospital, Mendota, IL, CCN 141310

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: carolyn.gale@perry.cernerdirect.com
• FHIR API: https://fhir4.healow.com/fhir/r4/AEIFAA

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.

• Osf Healthcare System

  dba Osf Holy Family Clinics

  • Rural Health Clinic/Center
  • Monmouth, IL
  • NPI 1679606073
  Medicare reassignment Care Compare group NPD (past)
• Osf Multi-Specialty Group

  • Internal Medicine Physician
  • Peoria, IL
  • NPI 1922445527
  Medicare reassignment
• Osf Healthcare System

  dba OSF Saint Katharine Medical Center

  • General Acute Care Hospital
  • Dixon, IL
  • NPI 1508683590
  NPD
• Osf Healthcare System

  dba OSF Healthcare - Medical Group

  • Family Medicine Physician
  • Henry, IL
  • NPI 1982311627
  NPD
• Central PA Pharmacy LLC.

  dba patton pharmacy and v&s variety

  • Community/Retail Pharmacy
  • Patton, PA
  • NPI 1578541413
  NPD
• Peninsula Community Health Services of Alaska, Inc.

  • Community/Behavioral Health Agency
  • Soldotna, AK
  • NPI 1124110796
  NPD (past)
• Peninsula Community Health Services of Alaska, Inc.

  • Federally Qualified Health Center (FQHC)
  • Kenai, AK
  • NPI 1659825776
  NPD (past)

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

• JKCD Healthcare Consulting, LLC

  dba In-Home Care Connection Home Health Services, LLC

  • Home Health Agency
  • Moline, IL
  • NPI 1184150419
  Care Compare affiliation
• Mendota Community Hospital

  dba OSF Saint Paul Medical Center

  • Critical Access Hospital
  • Mendota, IL
  • NPI 1609803113
  Care Compare affiliation
• Osf Healthcare System

  dba OSF Saint Clare Medical Center

  • Critical Access Hospital
  • Princeton, IL
  • NPI 1093308439
  Care Compare affiliation
• Osf Healthcare System

  dba OSF Saint Katharine Medical Center

  • General Acute Care Hospital
  • Dixon, IL
  • NPI 1508683590
  Care Compare affiliation
• Ottawa Regional Hospital & Healthcare Center

  dba OSF Saint Elizabeth Medical Center

  • General Acute Care Hospital
  • Peru, IL
  • NPI 1588713440
  Care Compare affiliation
• Saint Anthony Medical Center

  dba Saint Anthony Med. Ctr for Home Care

  • Home Health Agency
  • Loves Park, IL
  • NPI 1023051992
  Care Compare affiliation

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

{
    "created_epoch": "1191542400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1602720000000",
    "number": "1467640292",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 E MILLER RD",
            "city": "STERLING",
            "state": "IL",
            "postal_code": "610811252",
            "telephone_number": "815-625-4790"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 N MAIN ST",
            "city": "WALNUT",
            "state": "IL",
            "postal_code": "61376",
            "telephone_number": "815-379-2020",
            "fax_number": "815-379-2018"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2128 N Main St",
            "address_purpose": "LOCATION",
            "city": "Princeton",
            "state": "IL",
            "postal_code": "613569728",
            "country_code": "US",
            "telephone_number": "815-875-2273",
            "fax_number": "815-207-8682",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "327 Edward St",
            "address_purpose": "LOCATION",
            "city": "Henry",
            "state": "IL",
            "postal_code": "615371539",
            "country_code": "US",
            "telephone_number": "309-364-2002",
            "fax_number": "309-364-2017",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "530 Park Ave E",
            "address_purpose": "LOCATION",
            "city": "Princeton",
            "state": "IL",
            "postal_code": "61356",
            "country_code": "US",
            "telephone_number": "815-875-2811",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "535 Park Ave E",
            "address_purpose": "LOCATION",
            "city": "Princeton",
            "state": "IL",
            "postal_code": "613562537",
            "country_code": "US",
            "telephone_number": "815-875-4531",
            "fax_number": "815-876-2118",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GALE",
        "first_name": "CAROLYN",
        "middle_name": "JEAN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-10-05",
        "last_updated": "2020-10-15",
        "certification_date": "2020-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CO",
            "license": "2224",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "AK",
            "license": "5541",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085001195",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "carolyn.gale@perry.cernerdirect.com",
            "affiliation": "N",
            "address_1": "327 Edward St",
            "city": "Henry",
            "state": "IL",
            "country_code": "US",
            "postal_code": "615371539",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "carolyn.gale@perry.cernerdirect.com",
            "affiliation": "N",
            "address_1": "530 Park Ave E",
            "city": "Princeton",
            "state": "IL",
            "country_code": "US",
            "postal_code": "61356",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "CAROLYN",
            "last_name": "SHADOIN",
            "middle_name": "JEAN",
            "credential": "PA-C",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Physician Assistant in Walnut, IL
• Providers in Walnut, IL by specialty
• Physician Assistant in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.