Phillip Scott Gilliam, PA

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

2005017775 Issued in MO

Practice address

1509 W Truman Rd
Independence, MO 64050-3436

Phone

(816) 836-6901

Fax

(816) 836-4400

NPI assigned

Oct 19, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

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.

• Camden Emergency Group LLC

  • Emergency Medicine Physician
  • Osage Beach, MO
  • NPI 1003181637
  Medicare reassignment
• Little Blue Emergency Physicians LLC

  • Emergency Medicine Physician
  • Independence, MO
  • NPI 1609154061
  NPD (past)
• Missouri Em-I Medical Services, P.C.

  • Emergency Medicine Physician
  • Independence, MO
  • NPI 1245518604

  Physician Assistant

  NPD (past)
• Cumberland River Hospital Inc

  dba Cumberland River Physician Associates

  • Family Medicine Physician
  • Celina, TN
  • NPI 1558676445
  NPD (past)

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

{
    "created_epoch": "1161216000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1562544000000",
    "number": "1841372273",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 838",
            "city": "SHAWNEE MISSION",
            "state": "KS",
            "postal_code": "662010838",
            "telephone_number": "913-469-4244",
            "fax_number": "913-469-1939"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1509 W TRUMAN RD",
            "city": "INDEPENDENCE",
            "state": "MO",
            "postal_code": "640503436",
            "telephone_number": "816-836-6901",
            "fax_number": "816-836-4400"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "54 Hospital Dr",
            "address_purpose": "LOCATION",
            "city": "Osage Beach",
            "state": "MO",
            "postal_code": "650653050",
            "country_code": "US",
            "telephone_number": "573-348-8000",
            "fax_number": "573-348-8309",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GILLIAM",
        "first_name": "PHILLIP",
        "middle_name": "SCOTT",
        "name_prefix": "Mr.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-19",
        "last_updated": "2019-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MO",
            "license": "2005017775",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "MO",
            "license": "2005017775",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Taylor Gibson
• Tracy Giese
• Dawna Lynn Gilbert, ATC
• Skyler Gilbert
• Marjon M Gillbanks, M.D.
• Amy Leigh Gillihan, DMD
• Daniel Robert Gilstrap, DDS
• Charlotte Ginnings
• Margaret A Giokaris, LPC
• Mary Giordano, SLP

• Medical Physician Assistant in Independence, MO
• Providers in Independence, MO by specialty
• Medical Physician Assistant in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2019; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.