Active NPI
Jean Michel Elsasser, PA-C
- Physician Assistant
- Peoria, IL
National Provider Identifier
1477091536
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 085006097
- Practice address
- 530 NE Glen Oak Ave
Peoria, IL 61637-0001 - Phone
- (309) 655-7171
- NPI assigned
- Feb 8, 2017
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 085006097 | IL | Primary |
Addresses
Primary practice location
530 NE Glen Oak Ave
Peoria, IL 61637-0001
Mailing address
905 S 4TH Ave
Morton, IL 61550-2547
Phone (309) 251-3672
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 345321913 | Medicaid | IL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 085006097 | IL | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1486512000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1486512000000",
"number": "1477091536",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "905 S 4TH AVE",
"city": "MORTON",
"state": "IL",
"postal_code": "615502547",
"telephone_number": "309-251-3672"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "530 NE GLEN OAK AVE",
"city": "PEORIA",
"state": "IL",
"postal_code": "616370001",
"telephone_number": "309-655-7171"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELSASSER",
"first_name": "JEAN",
"middle_name": "MICHEL",
"name_prefix": "Mr.",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-02-08",
"last_updated": "2017-02-08",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "IL",
"license": "085006097",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "345321913",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Peoria, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2017; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.