Active NPI
James S Phares, PA
- Physician Assistant
- Urbana, IL
National Provider Identifier
1659417293
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 085002326
- Practice address
- 611 W Park St
Hvi
Urbana, IL 61801-2500 - Phone
- (217) 904-7000
- Fax
- (217) 904-7742
- NPI assigned
- Jan 30, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 085002326 | IL | Primary |
Addresses
Primary practice location
611 W Park St
Hvi
Urbana, IL 61801-2500
Mailing address
611 W Park St
BWPC
Urbana, IL 61801-2500
Phone (217) 383-6792
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 736 | IA | MD | Audiologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170115200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1399507200000",
"number": "1659417293",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "611 W PARK ST",
"address_2": "BWPC",
"city": "URBANA",
"state": "IL",
"postal_code": "618012500",
"telephone_number": "217-383-6792",
"fax_number": "217-383-4752"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "611 W PARK ST",
"address_2": "HVI",
"city": "URBANA",
"state": "IL",
"postal_code": "618012500",
"telephone_number": "217-904-7000",
"fax_number": "217-904-7742"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHARES",
"first_name": "JAMES",
"middle_name": "S",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-30",
"last_updated": "2014-05-08",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "IL",
"license": "085002326",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Urbana, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.