Edward Clay Travis, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

036086580 Issued in IL

Practice address

900 N. Washington St
Du Quoin, IL 62832

Phone

(618) 534-8538

NPI assigned

Aug 16, 2006

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 9

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

Family Practice

Education

Other, 1991

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Marshall Browning Hospital AssociationGroup PAC ID 9335049980, 31 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Marshall Browning Hospital Hospital, Du Quoin, IL, CCN 141331

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: edward.travis@mbhdq.medalliesdirect.net

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.

• Marshall Browning Hospital Association

  • Critical Access Hospital
  • Du Quoin, IL
  • NPI 1821099441

  IL

  Medicare reassignment Care Compare group NPD
• Marshall Browning Hospital Association

  • Rural Health Clinic/Center
  • Du Quoin, IL
  • NPI 1912490277
  Care Compare group NPD
• Marshall Browning Hospital Association

  • Rural Health Clinic/Center
  • Du Quoin, IL
  • NPI 1164666988
  Care Compare group NPD (past)

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

• Marshall Browning Hospital Association

  • Critical Access Hospital
  • Du Quoin, IL
  • NPI 1821099441

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1155686400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1581638400000",
    "number": "1801909700",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 N. WASHINGTON ST PO BOX 192",
            "city": "DU QUOIN",
            "state": "IL",
            "postal_code": "62832",
            "telephone_number": "618-534-8538"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 N. WASHINGTON ST",
            "city": "DU QUOIN",
            "state": "IL",
            "postal_code": "62832",
            "telephone_number": "618-534-8538"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TRAVIS",
        "first_name": "EDWARD",
        "middle_name": "CLAY",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-16",
        "last_updated": "2020-02-14",
        "certification_date": "2020-02-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036086580",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GHP INSURANCE NUMBER",
            "identifier": "46473",
            "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": "029889",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036086580",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "370661218401",
            "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": "080129731",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHLINK INSURANCE NUMB",
            "identifier": "253437",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GHP",
            "identifier": "324151",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sean A Thomas, LSW
• Emily Mackenzie Timmermann, OTD, OTR/L
• Manu Tongwarin, M.D
• Town & Country Pharmacies, Inc.
• Town & Country Pharmacies, Inc.
• Kathleen Vandermeer
• W Equine Escape LTD
• Melissa Kay Wade, MS CCC-SLP
• Wal-Mart Stores, Inc
• Walmart Inc.

• All providers in Du Quoin, IL
• Family Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 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.

Verify at the official NPI Registry.