Robert Lee Dougherty, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

085000498 Issued in IL

Practice address

412 NW 3Rd St
Casey, IL 62420-1014

Phone

(217) 932-4061

Fax

(217) 932-5191

NPI assigned

Aug 18, 2005

Last updated

Jul 9, 2007By the provider in NPPES

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Practice roles

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.

• Sarah Bush Lincoln Health Center

  dba FCH Greenville Family Medicine Clinic

  • Rural Health Clinic/Center
  • Greenville, IL
  • NPI 1811858970
  NPD (past)
• Sarah Bush Lincoln Health Center

  dba FCH Physician Billing

  • Critical Access Hospital
  • Vandalia, IL
  • NPI 1912988734
  NPD (past)

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

{
    "created_epoch": "1124323200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1891787529",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4114 E US 40",
            "city": "CASEY",
            "state": "IL",
            "postal_code": "624203113",
            "telephone_number": "217-382-4754",
            "fax_number": "217-932-5191"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "412 NW 3RD ST",
            "city": "CASEY",
            "state": "IL",
            "postal_code": "624201014",
            "telephone_number": "217-932-4061",
            "fax_number": "217-932-5191"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOUGHERTY",
        "first_name": "ROBERT",
        "middle_name": "LEE",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-18",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "IL",
            "license": "085000498",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Great Lakes EMS Inc.
• Cory D Hanley, PT
• Heartland Manor Inc Nursing Center

• Medical Physician Assistant in Casey, IL
• Providers in Casey, IL by specialty
• Medical Physician Assistant in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.