Active NPI
Elizabeth C. Ridley, PA
- Physician Assistant
- Swansea, IL
National Provider Identifier
1801036629
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 085004498
- Practice address
- 4948 Benchmark Centre Dr
Swansea, IL 62226-2027 - Phone
- (618) 628-2588
- Fax
- (618) 628-1363
- NPI assigned
- Mar 6, 2009
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 085004498 | IL | Primary |
Addresses
Primary practice location
4948 Benchmark Centre Dr
Swansea, IL 62226-2027
Mailing address
4948 Benchmark Centre Dr
Swansea, IL 62226-2027
Phone (618) 628-2588
Medicare participation
Medicare enrollment files- 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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20121102000194 | IL | Practitioner - Physician Assistant | 8224173141 | Reassigns benefits to 1 organization |
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Saint Louis University School of Medicine, 2008
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Musick Dermatology and Advanced Clinical Spa LLC
Practice addresses (Care Compare)
4948 Benchmark Centre Dr
Swansea, IL 62226-2027
Phone (618) 628-2588
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1236297600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1578009600000",
"number": "1801036629",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4948 BENCHMARK CENTRE DR",
"city": "SWANSEA",
"state": "IL",
"postal_code": "622262027",
"telephone_number": "618-628-2588",
"fax_number": "618-628-1363"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4948 BENCHMARK CENTRE DR",
"city": "SWANSEA",
"state": "IL",
"postal_code": "622262027",
"telephone_number": "618-628-2588",
"fax_number": "618-628-1363"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RIDLEY",
"first_name": "ELIZABETH",
"middle_name": "C.",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-03-06",
"last_updated": "2020-01-03",
"certification_date": "2020-01-03",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "IL",
"license": "085004498",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Swansea, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2020; 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.