Active NPI
James J Pavlovich, M.D.
- Pediatrics Physician
- Sesser, IL
National Provider Identifier
1679686745
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 036089862
- Practice address
- 6294 State Highway 154
Sesser, IL 62884 - Phone
- (618) 625-6979
- NPI assigned
- Aug 15, 2006
- Last updated
- Jun 11, 2019
- 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 |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 036089862 | IL | Primary |
Addresses
Primary practice location
6294 State Highway 154
Sesser, IL 62884
Mailing address
PO Box 155
Christopher, IL 62822-0155
Phone (618) 724-1624
Other practice location 1
2601 W Main St
Carbondale, IL 62901-1031
Phone (618) 549-5361 ext. 205
Other practice location 2
2601 W Main St
Carbondale, IL 62901-1031
Phone (618) 549-5361 ext. 205
Other identifiers 8
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 324148 | Other | IL | GHP |
| 3932056 | Other | IL | BCBS OF IL |
| 027538 | Other | IL | HAMP INSURANCE NUMBER |
| 271458 | Other | IL | HEALTHLINK |
| 7210895 | Other | IL | AETNA |
| 370007818 | Other | IL | RR MEDICARE NUMBER |
| 48175 | Other | IL | GHP INSURANCE NUMBER |
| 036089862 | Medicaid | IL |
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
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036089862 | IL | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155600000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1560211200000",
"number": "1679686745",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 155",
"city": "CHRISTOPHER",
"state": "IL",
"postal_code": "628220155",
"telephone_number": "618-724-1624",
"fax_number": "618-724-4628"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6294 STATE HIGHWAY 154",
"city": "SESSER",
"state": "IL",
"postal_code": "62884",
"telephone_number": "618-625-6979"
}
],
"practiceLocations": [
{
"address_1": "2601 W Main St",
"address_purpose": "LOCATION",
"city": "Carbondale",
"state": "IL",
"postal_code": "629011031",
"country_code": "US",
"telephone_number": "618-549-5361 x205",
"fax_number": "618-549-5128",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "2601 W Main St",
"address_purpose": "LOCATION",
"city": "Carbondale",
"state": "IL",
"postal_code": "629011031",
"country_code": "US",
"telephone_number": "618-549-5361 x205",
"fax_number": "618-549-5128",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "PAVLOVICH",
"first_name": "JAMES",
"middle_name": "J",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-15",
"last_updated": "2019-06-11",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "IL",
"license": "036089862",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GHP",
"identifier": "324148",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS OF IL",
"identifier": "3932056",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HAMP INSURANCE NUMBER",
"identifier": "027538",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTHLINK",
"identifier": "271458",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "7210895",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MEDICARE NUMBER",
"identifier": "370007818",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GHP INSURANCE NUMBER",
"identifier": "48175",
"state": "IL"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "036089862",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Sesser, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.