NPIMap

Individual provider Active NPI

Jason A Davison, NP-C

  • Adult Health Nurse Practitioner
  • Mount Vernon, IL
National Provider Identifier
1871867465
Registry record updated Oct 29, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
209009423 Issued in IL
Practice address
2 Good Samaritan Way
Suite 220
Mount Vernon, IL 62864-2408
Phone
(618) 899-3900
NPI assigned
Feb 29, 2012
Last updated
Oct 29, 2020By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 29, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X 209009423 IL Primary

Addresses

Primary practice location

2 Good Samaritan Way
Suite 220
Mount Vernon, IL 62864-2408

Mailing address

2 Good Samaritan Way
Suite 220
Mount Vernon, IL 62864-2408
Phone (618) 899-3900

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address jdavison76630@direct-ehr-ssmhc.com Direct
FHIR URL https://fhir.ssmhc.com/fhir/api/FHIR/DSTU2/ Other

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
I20120404000743 IL Practitioner - Nurse Practitioner 8325208093 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Select Physical Therapy Holdings IncGroup PAC ID 9537076401, shared by 76 NPIs, 1,992 clinicians
Physician Services Corporation of Southern Illinois IncGroup PAC ID 9234022567, 120 clinicians

Practice addresses (Care Compare)

326 E Main St
West Frankfort, IL 62896-2402
Phone (618) 937-6200

602 S 42ND St
B
Mount Vernon, IL 62864-6264
Phone (618) 899-3278

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Physician Services Corporation of Southern Illinois Inc. CurrentSince Jul 3, 2019 Accepting new patients

Locations

811 Fairfax St
Carlyle, IL 62231
Phone (618) 594-3025

1 Good Samaritan Way
Mount Vernon, IL 62864
Phone (618) 242-4600

2 Good Samaritan Way
Ste 220
Mount Vernon, IL 62864
Phone (618) 899-3900

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

602 S 42nd St
#B
Mount Vernon, IL 62864
Phone (618) 899-3278

605 N 12th St
Mount Vernon, IL 62864
Phone (618) 241-2200

17884 Exchange Ave
Nashville, IL 62263
Phone (618) 327-8486

3221 McKelvey Rd
Ste 301
Bridgeton, MO 63044

Interoperability endpoints

  • Direct secure messaging: jdavison76630@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 9

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": "1330473600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603929600000",
    "number": "1871867465",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2 GOOD SAMARITAN WAY",
            "address_2": "SUITE 220",
            "city": "MOUNT VERNON",
            "state": "IL",
            "postal_code": "628642408",
            "telephone_number": "618-899-3900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 GOOD SAMARITAN WAY",
            "address_2": "SUITE 220",
            "city": "MOUNT VERNON",
            "state": "IL",
            "postal_code": "628642408",
            "telephone_number": "618-899-3900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVISON",
        "first_name": "JASON",
        "middle_name": "A",
        "credential": "NP-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-02-29",
        "last_updated": "2020-10-29",
        "certification_date": "2020-10-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "IL",
            "license": "209009423",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jdavison76630@direct-ehr-ssmhc.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "jdavison76630@direct-ehr-ssmhc.com",
            "address_1": "2 Good Samaritan Way",
            "address_2": "Suite 220",
            "city": "Mount Vernon",
            "state": "IL",
            "country_code": "US",
            "postal_code": "628642408",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://fhir.ssmhc.com/fhir/api/FHIR/DSTU2/",
            "affiliation": "N",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "FHIR API",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCD",
            "address_1": "2 Good Samaritan Way",
            "address_2": "Suite 220",
            "city": "Mount Vernon",
            "state": "IL",
            "country_code": "US",
            "postal_code": "628642408",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Mount Vernon, IL

Sources for this page

Verify at the official NPI Registry.