Lindsey Buckles, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

085007107 Issued in IL

Practice address

903 S State St
Jerseyville, IL 62052-2344

Phone

(618) 639-9255

Fax

(618) 639-8100

NPI assigned

Mar 3, 2015

Last updated

Jun 19, 2023By 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 2

Addresses

Other identifiers 1

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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.

• Trinity Medical Staffing LLC

  • Internal Medicine Physician
  • Harrisburg, IL
  • NPI 1770103426
  Medicare reassignment

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

{
    "created_epoch": "1425340800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687132800000",
    "number": "1508258393",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "261 COVENTRY PL",
            "city": "EDWARDSVILLE",
            "state": "IL",
            "postal_code": "620251507",
            "telephone_number": "618-946-0299",
            "fax_number": "618-498-8439"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "903 S STATE ST",
            "city": "JERSEYVILLE",
            "state": "IL",
            "postal_code": "620522344",
            "telephone_number": "618-639-9255",
            "fax_number": "618-639-8100"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4921 Parkview Pl",
            "address_purpose": "LOCATION",
            "city": "Saint Louis",
            "state": "MO",
            "postal_code": "631101032",
            "country_code": "US",
            "telephone_number": "314-747-1369",
            "fax_number": "314-367-1943",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "400 Maple Summit Rd",
            "address_purpose": "LOCATION",
            "city": "Jerseyville",
            "state": "IL",
            "postal_code": "620522028",
            "country_code": "US",
            "telephone_number": "618-498-6402",
            "fax_number": "618-498-8439",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BUCKLES",
        "first_name": "LINDSEY",
        "name_prefix": "Mrs.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-03-03",
        "last_updated": "2023-06-19",
        "certification_date": "2023-06-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MO",
            "license": "2015007736",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085007107",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1508258393",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Bray & Seago Inc
• Emilee Anne Bridgwater
• James A Briggs, DC
• Chanelle Marie Brooks, BCBA
• Sarah Brown-Foiles, LCSW
• Mary Ann Buettner
• Chelseah Byrd
• Colleen M Canavan, PA
• Julia L Carroll, M.ED., L.C.P.C
• Alicia Renee Cater, LPC

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2023; 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.

Verify at the official NPI Registry.