Marty Caudle, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

4854 Issued in TN

Practice address

404 Durley St
Greenville, IL 62246

Phone

(618) 690-3595

Fax

(618) 690-3596

NPI assigned

Feb 13, 2009

Last updated

Jan 5, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

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 OR, IL2 enrollments

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 2

Specialty

Physician Assistant

Education

Saint Louis University School of Medicine, 1999

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

HSHS Holy Family Hospital IncGroup PAC ID 7517879349, 25 clinicians

St Josephs Hospital Breese of the Hospital Sisters of the Third OrdeGroup PAC ID 9638064892, 33 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• St Josephs Hospital Hospital, Breese, IL, CCN 140145
• HSHS Holy Family Hospital Inc Hospital, Greenville, IL, CCN 140137

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• St Josephs Hospital Breese of the Hospital Sisters of the Third Orde

  dba St. Joseph's Hospital

  • General Acute Care Hospital
  • Breese, IL
  • NPI 1457319154
  Medicare reassignment Care Compare group NPD
• HSHS Holy Family Hospital Inc

  • General Acute Care Hospital
  • Greenville, IL
  • NPI 1205850690
  Medicare reassignment Care Compare group
• HSHS Prairie, Inc

  • Multi-Specialty Clinic/Center
  • Springfield, IL
  • NPI 1962644807
  Medicare reassignment
• Legacy Clinics LLC

  • Clinic/Center
  • Portland, OR
  • NPI 1902827272
  Medicare reassignment
• HSHS Prairie, Inc

  dba HSHS Medical Group Family Medicine - Dieterich

  • Rural Health Clinic/Center
  • Dieterich, IL
  • NPI 1033841192
  NPD
• SJL Health Systems Inc

  dba Prairie Rose Health Care Center

  • Skilled Nursing Facility
  • Pana, IL
  • NPI 1215037353
  NPD
• St Josephs Hospital Breese of the Hospital Sisters of the Third Orde

  dba Clinton County Rural Health

  • Rural Health Clinic/Center
  • Breese, IL
  • NPI 1013002658
  NPD
• HSHS Holy Family Hospital Inc

  • Registered Dietitian
  • Greenville, IL
  • NPI 1558383968
  NPD (past)
• HSHS Medical Group Inc

  • Rural Health Clinic/Center
  • Rushville, IL
  • NPI 1487719480
  NPD (past)

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

• HSHS Holy Family Hospital Inc

  • General Acute Care Hospital
  • Greenville, IL
  • NPI 1205850690
  Care Compare affiliation
• St Josephs Hospital Breese of the Hospital Sisters of the Third Orde

  dba Clinton County Rural Health

  • Rural Health Clinic/Center
  • Breese, IL
  • NPI 1013002658

  Hospital

  Care Compare affiliation
• St Josephs Hospital Breese of the Hospital Sisters of the Third Orde

  dba St. Joseph's Hospital

  • General Acute Care Hospital
  • Breese, IL
  • NPI 1457319154
  Care Compare affiliation

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

{
    "created_epoch": "1234483200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1704412800000",
    "number": "1639318645",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "404 DURLEY ST",
            "city": "GREENVILLE",
            "state": "IL",
            "postal_code": "622461504",
            "telephone_number": "186-903-5956"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "404 DURLEY ST",
            "city": "GREENVILLE",
            "state": "IL",
            "postal_code": "62246",
            "telephone_number": "618-690-3595",
            "fax_number": "618-690-3596"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "12860 Troxler Ave",
            "address_purpose": "LOCATION",
            "city": "Highland",
            "state": "IL",
            "postal_code": "62249",
            "country_code": "US",
            "telephone_number": "618-651-2810",
            "fax_number": "618-651-0077",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "102 Wessington Pl",
            "address_purpose": "LOCATION",
            "city": "Hendersonville",
            "state": "TN",
            "postal_code": "370753085",
            "country_code": "US",
            "telephone_number": "615-822-2214",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CAUDLE",
        "first_name": "MARTY",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-02-13",
        "last_updated": "2024-01-05",
        "certification_date": "2024-01-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TN",
            "license": "4854",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OR",
            "license": "PA01451",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mcaudle421254@ewd.direct.hshs.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/CCD/TXT",
            "address_1": "404 Durley St",
            "city": "Greenville",
            "state": "IL",
            "country_code": "US",
            "postal_code": "62246",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Bridgemark of Greenville, LLC
• Crystal Mae Brown, APN
• Larry Dean Bruno, D.C.
• Charles Burns, MS,LCPC
• Crystal Marie Carmicheal, M.D.
• Cep America Illinois Intensivists
• Cep America-Illinois Hospitalists, LLP
• Cepamerica Illinois LLP
• Matthew Ray Chenault, D. C.
• Huzefa Chinwala, M.D.

• Physician Assistant in Greenville, IL
• Providers in Greenville, 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 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.
• 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.