Lyle D Pahnke Jr., MD

Primary specialty

Vascular Surgery PhysicianTaxonomy code 2086S0129X

License

036089773 Issued in IL

Practice address

400 N Pleasant Ave
Centralia, IL 62801-3056

Phone

(618) 436-6318

Fax

(618) 436-6386

NPI assigned

May 23, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 4

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

General SurgeryAlso: Vascular Surgery

Education

Other, 1970

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

St Marys Hospital Centralia IllinoisGroup PAC ID 6709788920, 118 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• SSM Health St Mary'S Hospital -Centralia Hospital, Centralia, IL, CCN 140034
• Good Samaritan Regional HLTH Center Hospital, Mount Vernon, IL, CCN 140046

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: lyle.pahnke@9346.chartlogic.direct-ci.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• St. Mary'S Hospital, Centralia, Illinois

  • Emergency Medicine Physician
  • Centralia, IL
  • NPI 1770687196
  Medicare reassignment Care Compare group NPD
• Good Samaritan Regional Health Center

  • Emergency Medicine Physician
  • Mount Vernon, IL
  • NPI 1487758801
  Medicare reassignment NPD
• Physician Services Corporation of Southern Illinois Inc.

  • Internal Medicine Physician
  • Mount Vernon, IL
  • NPI 1831101807

  Family Medicine

  Medicare reassignment NPD
• Good Samaritan Regional Health Center

  • Anesthesiology Physician
  • Mount Vernon, IL
  • NPI 1194269597
  NPD
• St. Mary'S Hospital, Centralia, Illinois

  • Comprehensive Outpatient Rehabilitation Facility (CORF)
  • Centralia, IL
  • NPI 1710105192
  NPD

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

• Good Samaritan Regional Health Center

  • General Acute Care Hospital
  • Mount Vernon, IL
  • NPI 1609897339
  Care Compare affiliation
• St Mary'S Hospital, Centralia, Illinois

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

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

{
    "created_epoch": "1148342400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649980800000",
    "number": "1770538225",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 N PLEASANT AVE",
            "city": "CENTRALIA",
            "state": "IL",
            "postal_code": "628013056",
            "telephone_number": "618-436-6318",
            "fax_number": "618-436-6386"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 N PLEASANT AVE",
            "city": "CENTRALIA",
            "state": "IL",
            "postal_code": "628013056",
            "telephone_number": "618-436-6318",
            "fax_number": "618-436-6386"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "302 Broadway St",
            "address_purpose": "LOCATION",
            "city": "Mount Vernon",
            "state": "IL",
            "postal_code": "628645116",
            "country_code": "US",
            "telephone_number": "618-242-4750",
            "fax_number": "618-242-7674",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PAHNKE",
        "first_name": "LYLE",
        "middle_name": "D",
        "name_suffix": "Jr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-23",
        "last_updated": "2022-04-15",
        "certification_date": "2022-04-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036089773",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "IL",
            "license": "036089773",
            "primary": false
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "IL",
            "license": "036089773",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR GROUP NUMBER",
            "identifier": "CG2264",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP",
            "identifier": "207988",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036089773",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE NUMBER",
            "identifier": "P00169541",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Orthopaedic Center of Southern Illinois, LTD.
• Kyniesha Overall
• Suzanne Joy Overstreet, MA CCC-SLP
• Brandi Overturf
• Mallory Owens, MSW
• Suchi Paris Lineberry, LCSW
• Brooke Felena Payne
• Dale D Pearce, APRN, FNP-C
• Kayla Ann Pearson
• Pediatric Group, LLC

• Vascular Surgery Physician in Centralia, IL
• Providers in Centralia, IL by specialty
• Vascular Surgery Physician in Illinois

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