NPIMap

Organization Active NPI

Gibson Community Hospital Association

Doing business as Family Healthcare of Fisher

  • General Practice Physician
  • Fisher, IL
National Provider Identifier
1508214404
Registry record updated Jun 1, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
GIBSON COMMUNITY HOSPITAL ASSOCIATION
Doing business as
Family Healthcare of Fisher
Practice address
104 S 3Rd St
Fisher, IL 61843-9549
Phone
(217) 897-1692
Fax
(217) 897-6027
NPI assigned
Jun 1, 2016
Last updated
Jun 1, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 1, 2016

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

Authorized official

Name
Mr. Bryan Coffey
Title
Chief Financial Officer
Phone
(217) 784-2601

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Physician 208D00000X Primary

Addresses

Primary practice location

104 S 3Rd St
Fisher, IL 61843-9549

Mailing address

104 S 3Rd St
Fisher, IL 61843-9549
Phone (217) 897-1692

Other names 1

  • Family Healthcare of Fisher Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040505001293 IL Part B Supplier - Clinic/Group Practice 5092703124 Receives reassigned benefits from 201 practitioners
38 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Watseka, IL; Urbana, IL; Paxton, IL; Fairbury, IL; Onarga, IL; Mahomet, IL; Hoopeston, IL; Gibson City, IL…

Other NPIs on the same Medicare enrollment 38

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 38

National Provider Directory

National Provider Directory
Tax ID family
The Paxton Clinic43 organizations share this tax ID, including this one

Other organizations with this tax ID 42

Organizations that report the same tax identification number in the National Provider Directory.

View all 42

Locations

4 Doctors Park
Gibson City, IL 60936
Phone (217) 784-4540

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1464739200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1464739200000",
    "number": "1508214404",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "104 S 3RD ST",
            "city": "FISHER",
            "state": "IL",
            "postal_code": "618439549",
            "telephone_number": "217-897-1692",
            "fax_number": "217-897-6027"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 S 3RD ST",
            "city": "FISHER",
            "state": "IL",
            "postal_code": "618439549",
            "telephone_number": "217-897-1692",
            "fax_number": "217-897-6027"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GIBSON COMMUNITY HOSPITAL ASSOCIATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-06-01",
        "last_updated": "2016-06-01",
        "status": "A",
        "authorized_official_last_name": "COFFEY",
        "authorized_official_first_name": "BRYAN",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "217-784-2601",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Family Healthcare of Fisher",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fisher, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.