Active NPI
Ronald Aurthur Degon, RSA, SA-C, CSA
- Surgical Assistant
- Bloomington, IL
National Provider Identifier
1891837696
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgical Assistant
- License
- 238.000139
- Practice address
- 1804 Glenbridge Rd
Bloomington, IL 61704-8769 - Phone
- (309) 831-8326
- NPI assigned
- Feb 12, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgical Assistant | 246ZC0007X | 238.000139 | IL | Primary |
Addresses
Primary practice location
1804 Glenbridge Rd
Bloomington, IL 61704-8769
Mailing address
1804 Glenbridge Rd
Bloomington, IL 61704-8769
Phone (309) 831-8326
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 238.000139 | Other | IL | STATE OF ILLINOIS REGISTRATION NUMBER |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 238.000139 | IL | MD | Surgical Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1171238400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1370476800000",
"number": "1891837696",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1804 GLENBRIDGE RD",
"city": "BLOOMINGTON",
"state": "IL",
"postal_code": "617048769",
"telephone_number": "309-831-8326"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1804 GLENBRIDGE RD",
"city": "BLOOMINGTON",
"state": "IL",
"postal_code": "617048769",
"telephone_number": "309-831-8326"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEGON",
"first_name": "RONALD",
"middle_name": "AURTHUR",
"credential": "RSA, SA-C, CSA",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-02-12",
"last_updated": "2013-06-06",
"status": "A"
},
"taxonomies": [
{
"code": "246ZC0007X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Other, Surgical Assistant",
"state": "IL",
"license": "238.000139",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE OF ILLINOIS REGISTRATION NUMBER",
"identifier": "238.000139",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bloomington, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.