Braedon Haertling, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

085007253 Issued in IL

Practice address

4121 Veterans Memorial Dr
Mount Vernon, IL 62864-6262

Phone

(618) 214-8392

NPI assigned

Sep 11, 2019

Last updated

Jan 30, 2025By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

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

Specialty

Physician Assistant

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Select Physical Therapy Holdings IncGroup PAC ID 9537076401, shared by 76 NPIs, 1,992 clinicians

Orthopaedic Center of Southern Illinois, LTDGroup PAC ID 6901705441, 18 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• SSM Health at Home Health-Illinois Home health agency, Mount Vernon, IL, CCN 147088
• Good Samaritan Regional HLTH Center Hospital, Mount Vernon, IL, CCN 140046
• SSM Health St Mary's Hospital -Centralia Hospital, Centralia, IL, CCN 140034
• Washington County Hospital Hospital, Nashville, IL, CCN 141308
• Fairfield Memorial Hospital 1 Hospital, Fairfield, IL, CCN 141311
• Pinckneyville Community Hospital Hospital, Pinckneyville, IL, CCN 141307

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: bhaertling@ocsi1706.srs-direct.com

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.

• Orthopaedic Center of Southern Illinois, LTD.

  • Orthopaedic Surgery Physician
  • Mount Vernon, IL
  • NPI 1134171226
  Medicare reassignment Care Compare group
• Orthopaedic Center of Southern Illinois, LTD.

  • Orthopaedic Surgery Physician
  • Centralia, IL
  • NPI 1932432143
  NPD

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

• Fairfield Memorial Hospital Association

  • Critical Access Hospital
  • Fairfield, IL
  • NPI 1255422416
  Care Compare affiliation
• Good Samaritan Regional Health Center

  dba SSM Health Good Samaritan Hospital - Mt. Vernon

  • General Acute Care Hospital
  • Mount Vernon, IL
  • NPI 1609897339
  Care Compare affiliation
• Pinckneyville Community Hospital

  • Critical Access Hospital
  • Pinckneyville, IL
  • NPI 1689646523
  Care Compare affiliation
• SSM Health Businesses

  dba SSM Health at Home Home Health Glen Carbon

  • Home Health Agency
  • Mount Vernon, IL
  • NPI 1295798403
  Care Compare affiliation
• St Mary's Hospital, Centralia, Illinois

  dba SSM Health St. Mary's Hospital - Centralia

  • General Acute Care Hospital
  • Centralia, IL
  • NPI 1083617245
  Care Compare affiliation
• Washington County Hospital District

  dba Washington County Hospital Walk In Clinic

  • Rural Health Clinic/Center
  • Nashville, IL
  • NPI 1316555816

  Hospital

  Care Compare affiliation
• Washington County Hospital District

  dba Washington County Hospital

  • Critical Access Hospital
  • Nashville, IL
  • NPI 1659321560
  Care Compare affiliation

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

{
    "created_epoch": "1568160000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1738195200000",
    "number": "1689223729",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4121 VETERANS MEMORIAL DR",
            "city": "MOUNT VERNON",
            "state": "IL",
            "postal_code": "628646262",
            "telephone_number": "618-242-3778"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4121 VETERANS MEMORIAL DR",
            "city": "MOUNT VERNON",
            "state": "IL",
            "postal_code": "628646262",
            "telephone_number": "618-214-8392"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAERTLING",
        "first_name": "BRAEDON",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-09-11",
        "last_updated": "2025-01-30",
        "certification_date": "2025-01-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085007253",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHYSICIAN ASSISTANT LICENSE",
            "identifier": "085007253",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Anil Gupta, M.D.
• Veena Kawatra Gupta, M.D.
• Shelby Guthrie, FNP
• Susan Guthrie, MS, CCC-SLP
• Jamie Hackmann, MSW, CADC
• Devin D Haertling, PA-C
• Whitney Hake
• Sharon Lynn Hale
• Dylan Matthew Hall, MHP
• Tina Hall

• Physician Assistant in Mount Vernon, IL
• Providers in Mount Vernon, IL by specialty
• Physician Assistant in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.