NPIMap

Individual provider Active NPI

William Edward Buckett, PHYSICIAN ASSISTANT

  • Medical Physician Assistant
  • Centralia, IL
National Provider Identifier
1851481824
Registry record updated Nov 12, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
009118 Issued in NY
Practice address
1054 Martin Luther King Dr
Ste 124
Centralia, IL 62801-3000
Phone
(618) 533-8700
Fax
(618) 533-8701
NPI assigned
Oct 13, 2006
Last updated
Nov 12, 2015By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 12, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 009118 NY Primary

Addresses

Primary practice location

1054 Martin Luther King Dr
Ste 124
Centralia, IL 62801-3000

Mailing address

1054 Martin Luther King Dr
Ste 124
Centralia, IL 62801-3000
Phone (618) 533-8700

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210721003773 IL Practitioner - Physician Assistant 6709776404 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Physician Services Corporation of Southern Illinois IncGroup PAC ID 9234022567, 120 clinicians

Practice addresses (Care Compare)

2 Good Samaritan Way
Mount Vernon, IL 62864-2476

2 Good Samaritan Way
Suite 320
Mount Vernon, IL 62864-2408
Phone (618) 899-1944

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Interoperability endpoints

  • Direct secure messaging: wbuckett123212@direct-ehr-ssmhc.com

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 6

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

NPI Registry JSON

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

{
    "created_epoch": "1160697600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1447286400000",
    "number": "1851481824",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1054 MARTIN LUTHER KING DR",
            "address_2": "STE 124",
            "city": "CENTRALIA",
            "state": "IL",
            "postal_code": "628013000",
            "telephone_number": "618-533-8700",
            "fax_number": "618-533-8701"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1054 MARTIN LUTHER KING DR",
            "address_2": "STE 124",
            "city": "CENTRALIA",
            "state": "IL",
            "postal_code": "628013000",
            "telephone_number": "618-533-8700",
            "fax_number": "618-533-8701"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUCKETT",
        "first_name": "WILLIAM",
        "middle_name": "EDWARD",
        "name_prefix": "Mr.",
        "credential": "PHYSICIAN ASSISTANT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-13",
        "last_updated": "2015-11-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NY",
            "license": "009118",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Centralia, IL

Sources for this page

Verify at the official NPI Registry.