Marion Elsa Gabou Dessalines, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

085010947 Issued in IL

Practice address

2122 Troy Rd Ste 130
Edwardsville, IL 62025-2540

Phone

(618) 800-4595

Fax

(618) 800-4501

NPI assigned

Oct 29, 2024

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Electronic endpoints 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

Specialty

Physician Assistant

Education

Other, 2024

Medicare assignment

May accept Medicare assignment

Group practices

Fairview Heights Medical Group SCGroup PAC ID 6800784083, 448 clinicians

Belleville Urgent Care Walk-in ClinicGroup PAC ID 4183050362, 5 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Fairview Heights Medical Group SC

  • Multi-Specialty Clinic/Center
  • Saint Louis, MO
  • NPI 1679503668

  IL

  Medicare reassignment Care Compare group NPD (past)
• Belleville Urgent Care Walk-in Clinic

  • Family Medicine Physician
  • Belleville, IL
  • NPI 1225694946
  Medicare reassignment Care Compare group
• Alton Urgent Care Walk in Clinic Company

  • Family Medicine Physician
  • Alton, IL
  • NPI 1013521343
  Medicare reassignment
• Granite City Urgent Care Walk-in Clinic

  • Urgent Care Clinic/Center
  • Granite City, IL
  • NPI 1659861953
  Medicare reassignment
• Waterloo Urgent Care Walk in Clinic Company

  • Family Medicine Physician
  • Waterloo, IL
  • NPI 1508471418
  Medicare reassignment
• Wood River Urgent Care and Walk in Clinic Inc

  • Family Medicine Physician
  • Wood River, IL
  • NPI 1427717438
  Medicare reassignment
• Fairview Heights Medical Group SC

  • Multi-Specialty Clinic/Center
  • Saint Louis, MO
  • NPI 1073022000
  NPD
• Farmington Hills Urgent Care Walk-in Clinic PC

  • Urgent Care Clinic/Center
  • Farmington Hills, MI
  • NPI 1144956350
  NPD
• Doctors Urgent Care Southfield

  • Urgent Care Clinic/Center
  • Southfield, MI
  • NPI 1326660929
  NPD (past)

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

{
    "created_epoch": "1730160000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1769731200000",
    "number": "1548082647",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 959203",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631959203",
            "telephone_number": "618-800-4595",
            "fax_number": "618-800-4501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2122 TROY RD STE 130",
            "city": "EDWARDSVILLE",
            "state": "IL",
            "postal_code": "620252540",
            "telephone_number": "618-800-4595",
            "fax_number": "618-800-4501"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2861 Madison Ave",
            "address_purpose": "LOCATION",
            "city": "Granite City",
            "state": "IL",
            "postal_code": "620403614",
            "country_code": "US",
            "telephone_number": "618-709-7723",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2801 W Main St",
            "address_purpose": "LOCATION",
            "city": "Belleville",
            "state": "IL",
            "postal_code": "622266646",
            "country_code": "US",
            "telephone_number": "618-416-2018",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DESSALINES",
        "first_name": "MARION",
        "middle_name": "ELSA GABOU",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-10-29",
        "last_updated": "2026-01-30",
        "certification_date": "2026-01-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085010947",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2",
            "affiliation": "N",
            "endpointDescription": "BJC",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "2122 Troy Rd Ste 130",
            "city": "Edwardsville",
            "state": "IL",
            "country_code": "US",
            "postal_code": "620252540",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Mary Deleonardis, LCSW
• Raife Deniz Demirer, RPH
• Beth Ann Denmon, FNP
• Megan Denton, LCPC
• Harry J Deppe, PHD
• Robert Paul Devine, D.C.
• Kassidy Ann Dexheimer
• Mary Elizabeth Di Lisio, DMD
• Diane Gassiraro PC
• Dierbergs Markets Inc

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2026; 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.