Ebun Osaze, PA
Individual provider Active NPI Physician Assistant · Danville, IL
NPI 1487705471 · NPPES record last updated May 8, 2014
Key facts
- NPI
- 1487705471
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 85001739 (IL)
- Practice address
- 311 W. Fairchild Street
Family Medicine/Convenient Care
Danville, IL 61832 - Phone
- (217) 431-7650
- Fax
- (217) 431-7634
- NPI assigned
- Jan 16, 2007
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 6
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20040706000038 | IL | Practitioner - Physician Assistant | 6204813579 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 85001739 | IL | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Hoopeston Community Memorial Hospital | Current | Accepting new patients | |
| Carle Health Care Incorporated | Current |
Accepting new patients | |
| Hoopeston Community Memorial Hospital | Current |
Accepting new patients | |
| Carle Health Care Incorporated | Past | Accepting new patients | |
| Gibson Community Hospital Association | Past | Accepting new patients |
Locations
2300 N Vermilion St
Danville, IL 61832
Phone (217) 431-7600
311 W Fairchild St
Danville, IL 61832
Phone (217) 431-7600
701 E Orange St
Hoopeston, IL 60942
Phone (217) 283-5531
611 W Park St
Urbana, IL 61801
Phone (217) 383-6941
Interoperability endpoints
- eosazepa47737@carlehiedirect.net
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 85001739 | IL | Yes |
Addresses
Primary practice location
311 W. Fairchild Street
Family Medicine/Convenient Care
Danville, IL 61832
Mailing address
611 W Park St
BWPC
Urbana, IL 61801-2529
Phone (217) 383-6792
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| P00156941 | Other | IL | RAILROAD |
| 0533210001 | Other | IL | DMERC |
Other providers in Danville, IL
- Evelyn L Ondevilla
- Alice A Oneil-Hoskins
- Susan Oneill
- Oneopto Il 2 PLLC
- Matthew Ong
- Carla Marie Osborn-Dubois
- Osf Healthcare System
- Osf Healthcare System
- Osf Healthcare System
- Osf Multi-Specialty Group
All providers in Danville, IL · Physician Assistant in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 8, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.