Maria Paniamogan, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

085002064 Issued in IL

Practice address

612 35TH Ave Ste 1
Moline, IL 61265-6176

Phone

(309) 788-0014

Fax

(309) 623-4638

NPI assigned

Feb 13, 2006

Last updated

Jun 15, 2022By the provider in NPPES

Sex

Female

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 4

Medicare fee-for-service enrollment

Enrolled in MO

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, 2002

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Health Facilities Rehab Services IncGroup PAC ID 3476679226, 152 clinicians

Southeast Missouri Hospital Physicians LLCGroup PAC ID 9133024334, 206 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Mercy Hospital Southeast Hospital, Cape Girardeau, MO, CCN 260110
• Mercy Hospital Stoddard Hospital, Dexter, MO, CCN 260160
• Missouri Delta Medical Center Hospital, Sikeston, MO, CCN 260113

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science, Physician Assistant

Practice roles

Locations

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.

• Southeast Missouri Hospital Physicians, LLC

  dba Mercy Clinic Southeast

  • Family Medicine Physician
  • Cape Girardeau, MO
  • NPI 1558311522
  Medicare reassignment Care Compare group NPD
• Health Facilities Rehab Services Inc

  • Rehabilitation Clinic/Center
  • Sikeston, MO
  • NPI 1720003551
  Care Compare group

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

• Missouri Delta Medical Center

  • General Acute Care Hospital
  • Sikeston, MO
  • NPI 1831269539
  Care Compare affiliation
• Southeast Health Center of Stoddard County, LLC

  dba Mercy Hospital Stoddard

  • General Acute Care Hospital
  • Dexter, MO
  • NPI 1801990825
  Care Compare affiliation
• Southeast Hospital

  dba Mercy Hospital Southeast

  • General Acute Care Hospital
  • Cape Girardeau, MO
  • NPI 1811006661
  Care Compare affiliation

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

{
    "created_epoch": "1139788800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655251200000",
    "number": "1760455398",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "612 35TH AVE STE 1",
            "city": "MOLINE",
            "state": "IL",
            "postal_code": "612656176",
            "telephone_number": "309-788-0014",
            "fax_number": "309-623-4638"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "612 35TH AVE STE 1",
            "city": "MOLINE",
            "state": "IL",
            "postal_code": "612656176",
            "telephone_number": "309-788-0014",
            "fax_number": "309-623-4638"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PANIAMOGAN",
        "first_name": "MARIA",
        "name_prefix": "Mrs.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-02-13",
        "last_updated": "2022-06-15",
        "certification_date": "2022-06-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085002064",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "JOHN DEERE",
            "identifier": "IL01V2",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCWELLMARK MOLINE",
            "identifier": "92068",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCWELLMARK E MOLINE",
            "identifier": "98786",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCILLINOIS",
            "identifier": "085002064",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Robert Allen Osborn, RPH
• Marcia A Overton, MEDICAL ASSISTANT
• Elisa Padro
• Megan Alexandra Page, MSW, LCSW
• Palmer College Foundation
• Pamela C. Papas-Corden, M.D.
• Ancilla Louise Parducci
• Alex J Pareigis, MD
• Elizabeth Ruta Pareigis, M.D.
• Bobbi Park, FNP-C

• Physician Assistant in Moline, IL
• Providers in Moline, IL by specialty
• Physician Assistant in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2022; 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.