Halley M Barke, PAC
Individual provider Active NPI Physician Assistant · Anna, IL
NPI 1669612438 · NPPES record last updated Apr 25, 2016
Key facts
- NPI
- 1669612438
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 085.003421 (IL)
- Practice address
- 513 N Main St
Anna, IL 62906-1668 - Phone
- (618) 833-4471
- Fax
- (618) 833-6267
- NPI assigned
- Mar 5, 2009
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20110826000733 | IL | Order and Referring Only - Physician Assistant | 2466621768 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 085.003421 | IL | MD | Physician Assistant |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 085.003421 | IL | Yes |
Addresses
Primary practice location
513 N Main St
Anna, IL 62906-1668
Mailing address
513 N Main St
Anna, IL 62906-1668
Phone (618) 833-4471
Other providers in Anna, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 25, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.