Jacob Bayley Sholl, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

Practice address

701 N 1St St
Springfield, IL 62781-0001

Phone

(217) 788-3030

NPI assigned

Jul 2, 2024

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

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.

• Abraham Lincoln Memorial Hospital

  • Certified Registered Nurse Anesthetist
  • Lincoln, IL
  • NPI 1558586180
  Medicare reassignment NPD
• Abraham Lincoln Memorial Hospital

  • Critical Access Hospital
  • Lincoln, IL
  • NPI 1154329753
  Medicare reassignment
• Midwest Emergency Department Specialists LTD

  • Emergency Medicine Physician
  • Springfield, IL
  • NPI 1245263367
  Medicare reassignment
• Abraham Lincoln Memorial Hospital

  • Critical Access Hospital
  • Lincoln, IL
  • NPI 1255304721
  NPD

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

{
    "created_epoch": "1719878400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722816000000",
    "number": "1629814348",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "701 N 1ST ST",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627810001",
            "telephone_number": "217-788-3156",
            "fax_number": "217-788-6459"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 N 1ST ST",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627810001",
            "telephone_number": "217-788-3030"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2300 N Edward St",
            "address_purpose": "LOCATION",
            "city": "Decatur",
            "state": "IL",
            "postal_code": "625264163",
            "country_code": "US",
            "telephone_number": "217-876-8121",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "200 Stahlhut Dr",
            "address_purpose": "LOCATION",
            "city": "Lincoln",
            "state": "IL",
            "postal_code": "626565066",
            "country_code": "US",
            "telephone_number": "217-732-2161",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHOLL",
        "first_name": "JACOB",
        "middle_name": "BAYLEY",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-07-02",
        "last_updated": "2024-08-05",
        "certification_date": "2024-08-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Abigail Mae Shields, RBT
• Peter Shih
• Sang H Shin, MD
• Akhil Shivaprasad, MD
• Kavya Shivaram, MD
• Shopko Stores Operating Co LLC
• Shopko Stores Operating Co. LLC
• Shopko Stores Operating Co. LLC
• Kelcy S Short, LCPC
• Michael Short, PHARM.D., BCPS

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2024; 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.