Individual provider Active NPI

Candida Ann Halley, PA-C

  • Physician Assistant
  • Mattoon, IL
National Provider Identifier
1639510423
Registry record updated Mar 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
1111808 Issued in IL
Practice address
1000 Health Center Dr Ste 101
Mattoon, IL 61938-4644
Phone
(217) 258-4020
Fax
(217) 258-4023
NPI assigned
Jul 9, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 5, 2024

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 1111808 IL Primary

Addresses

Primary practice location

1000 Health Center Dr Ste 101
Mattoon, IL 61938-4644

Mailing address

PO Box 372
Mattoon, IL 61938-0372

Other practice location 1

1900 W Polk St
Chicago, IL 60612-3723
Phone (312) 864-0452

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, 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

Enrollment IDStateProvider typePAC IDDetails
I20141103001557 NY Practitioner - Physician Assistant 3072735273 Reassigns benefits to 3 organizations
I20240319000574 IL Practitioner - Physician Assistant 3072735273 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sigma Health PCGroup PAC ID 2961305693, 22 clinicians

Practice addresses (Care Compare)

10640 165TH St
Orland Park, IL 60467-8734

10640 W 165TH St
Orland Park, IL 60467-8734
Phone (708) 364-0261

Merit-based Incentive Payment System (MIPS)

Final score
73.63 of 100Reported as group
Quality
64.83
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
88.96 of 100Reported as apm
Quality
69.5
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
1111808ILMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Auburn Memorial Medical Services, PC CurrentSince Oct 1, 2022 Accepting new patients
Sarah Bush Lincoln Health Center CurrentSince Mar 20, 2024 Accepting new patients
Sarah Bush Lincoln Health Center CurrentSince Mar 20, 2024 Accepting new patients
Emergency Physician Services of New York, P.C. Physician Assistant Past Accepting new patients
Sarah Bush Lincoln Health Center PastSince Mar 12, 2024 Accepting new patients

Locations

1000 Health Center Dr
Mattoon, IL 61938
Phone (217) 258-2389

1000 Health Center Dr
Ste 101
Mattoon, IL 61938
Phone (217) 258-4020

101 Professional Plz
Mattoon, IL 61938
Phone (217) 238-3730

77 Nelson St
Ste 120
Auburn, NY 13021
Phone (315) 252-7550

17 Lansing St
Sennett, NY 13021
Phone (315) 255-7011

Organizations & group practices 9

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.

NPI Registry JSON

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

{
    "created_epoch": "1373328000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1709596800000",
    "number": "1639510423",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 372",
            "city": "MATTOON",
            "state": "IL",
            "postal_code": "619380372"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 HEALTH CENTER DR STE 101",
            "city": "MATTOON",
            "state": "IL",
            "postal_code": "619384644",
            "telephone_number": "217-258-4020",
            "fax_number": "217-258-4023"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1900 W Polk St",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606123723",
            "country_code": "US",
            "telephone_number": "312-864-0452",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HALLEY",
        "first_name": "CANDIDA",
        "middle_name": "ANN",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-07-09",
        "last_updated": "2024-03-05",
        "certification_date": "2024-03-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "1111808",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mattoon, IL

Sources for this page

Verify at the official NPI Registry.