Shoshana B Church, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

085-002122 Issued in IL

Practice address

1006 South Division Street
Carterville, IL 62918-1539

Phone

(618) 985-4841

Fax

(618) 985-8101

NPI assigned

Aug 2, 2005

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 5

Other names 1

• Barbara W Church Former name

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

University of Nebraska College of Medicine, 2008

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Priority Integrated Healthcare PCGroup PAC ID 3779948245, 4 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Northwestern Medicine Central Dupage Hospital Hospital, Winfield, IL, CCN 140242
• Herrin Hospital Hospital, Herrin, IL, CCN 140011

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/26231/brand/1/csg/1/fhir/r4

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.

• Priority Integrated Healthcare PC

  • Family Medicine Physician
  • Marion, IL
  • NPI 1780345041
  Medicare reassignment Care Compare group NPD
• Integrated Health of Southern Illinois, LTD.

  • Sports Medicine (Family Medicine) Physician
  • Harrisburg, IL
  • NPI 1982738274
  Medicare reassignment
• Integrated Health of Southern Illinois

  • Family Medicine Physician
  • Carterville, IL
  • NPI 1790235497
  NPD
• Shawnee Health Service and Development Corp

  dba Shawnee Health Care, Carbondale

  • Federally Qualified Health Center (FQHC)
  • Carbondale, IL
  • NPI 1073745345
  NPD (past)
• Shawnee Health Service and Development Corp

  dba Shawnee Health Care, Carterville

  • Federally Qualified Health Center (FQHC)
  • Carterville, IL
  • NPI 1811928732
  NPD (past)
• Shawnee Health Service and Development Corp

  dba Marion Wellness

  • Federally Qualified Health Center (FQHC)
  • Marion, IL
  • NPI 1881624161
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Central Dupage Hospital Association

  dba Northwestern Medicine Central Dupage Hospital

  • General Acute Care Hospital
  • Winfield, IL
  • NPI 1003864810
  Care Compare affiliation
• Central Dupage Hospital Association

  dba Northwestern Medicine Central Dupage Hospital

  • Psychiatric Hospital Unit
  • Winfield, IL
  • NPI 1740230895
  Care Compare affiliation
• Southern Illinois Hospital Services

  dba Herrin Hospital

  • General Acute Care Hospital
  • Herrin, IL
  • NPI 1528158573
  Care Compare affiliation

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

{
    "created_epoch": "1122940800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1347494400000",
    "number": "1548261449",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P O BOX 577",
            "address_2": "109 CALIFORNIA",
            "city": "CARTERVILLE",
            "state": "IL",
            "postal_code": "629180577",
            "telephone_number": "618-985-8221",
            "fax_number": "618-985-4635"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1006 SOUTH DIVISION STREET",
            "city": "CARTERVILLE",
            "state": "IL",
            "postal_code": "629181539",
            "telephone_number": "618-985-4841",
            "fax_number": "618-985-8101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHURCH",
        "first_name": "SHOSHANA",
        "middle_name": "B",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-08-02",
        "last_updated": "2012-09-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085-002122",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "085002122",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH ALLIANCE",
            "identifier": "169746",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RR",
            "identifier": "CF3444",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE FQHC FOR SHAWNEE HEALTH SERVICES",
            "identifier": "141816",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "370966854004",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "BARBARA",
            "last_name": "CHURCH",
            "middle_name": "W",
            "credential": "PA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Mary K Chapman, NP
• Deanna Childers, LCPC
• Lakshmi Manogna Chintalacheruvu, MD
• Christian Social Services of Illinois (Caritas Family Solutions)
• Hunter Church
• City of Carterville
• Angela Dawn Clay, MS CCC-SLP
• John Robert Clement, MD
• Darneshia Coleman
• Angela Congiardo, LPN

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2012; 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.