Individual provider Active NPI

Brandon R Gale, PA

  • Physician Assistant
  • Peoria, IL
National Provider Identifier
1639319536
Registry record updated Dec 31, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
085003438 Issued in IL
Practice address
6000 N Allen Rd
Peoria, IL 61614-3294
Phone
(309) 691-1400
Fax
(309) 693-3154
NPI assigned
Mar 5, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 31, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 085003438 IL Primary

Addresses

Primary practice location

6000 N Allen Rd
Peoria, IL 61614-3294

Mailing address

6000 N Allen Rd
Peoria, IL 61614-3294
Phone (309) 691-1400

Other identifiers 1

IdentifierTypeStateIssuer
085003438MedicaidIL

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20090831000309 IL Practitioner - Physician Assistant 6305991183 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Midwest Orthopaedic Center S CGroup PAC ID 8022917715, 45 clinicians
Advanced Physical Therapy Services, LTD.Group PAC ID 9133101462, shared by 5 NPIs, 216 clinicians

Practice addresses (Care Compare)

6000 N Allen Rd
Peoria, IL 61614-3294
Phone (309) 691-1400

61 E Side SQ
Canton, IL 61520-2603
Phone (309) 649-1572

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine, Physician Assistant

State licenses

LicenseStateTypeSpecialty
085003438ILMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Gibson Community Hospital Association Past Accepting new patients

Organizations & group practices 2

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.

Hospital & facility affiliations 4

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

NPI Registry JSON

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

{
    "created_epoch": "1236211200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1577750400000",
    "number": "1639319536",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6000 N ALLEN RD",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616143294",
            "telephone_number": "309-691-1400",
            "fax_number": "309-689-7094"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6000 N ALLEN RD",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616143294",
            "telephone_number": "309-691-1400",
            "fax_number": "309-693-3154"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GALE",
        "first_name": "BRANDON",
        "middle_name": "R",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-03-05",
        "last_updated": "2019-12-31",
        "certification_date": "2019-12-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085003438",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "085003438",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Peoria, IL

Sources for this page

Verify at the official NPI Registry.