Wayne Blevins Jr.

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

PA2642 Issued in FL

Practice address

11574 RT 108
Carlinville, IL 62626-4091

Phone

(217) 854-4319

Fax

(217) 854-2765

NPI assigned

Jul 6, 2005

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

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in IL

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

Interoperability endpoints

• Direct secure messaging: wayneblevins@macoupinfm.allscriptsdirect.net

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.

• Macoupin Family Practice Centers LLP

  • Family Medicine Physician
  • Gillespie, IL
  • NPI 1699899070
  NPD (past)

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

{
    "created_epoch": "1120608000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1429747200000",
    "number": "1902803869",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "715 BROADWAY ST",
            "city": "GILLESPIE",
            "state": "IL",
            "postal_code": "620331166",
            "telephone_number": "217-839-4491",
            "fax_number": "205-313-5299"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11574 RT 108",
            "city": "CARLINVILLE",
            "state": "IL",
            "postal_code": "626264091",
            "telephone_number": "217-854-4319",
            "fax_number": "217-854-2765"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLEVINS",
        "first_name": "WAYNE",
        "name_suffix": "Jr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-06",
        "last_updated": "2015-04-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "FL",
            "license": "PA2642",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085004267",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "U4077Z",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEPT OF LABOR",
            "identifier": "606478700",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH PARTNERS",
            "identifier": "96317",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Bankhead Alton Orthodontics PC
• Brenda I Beanblossom, MA LCPC
• Behavior Rehab
• Kelly Suzanne Behme, MA CCC-SLP/L
• Molly Jo Bergman, PHARMD
• Katherine Boente, D.M.D.
• Steven John Boente, D.M.D.
• Kaitlin E Borgini
• Katelyn Elizabeth Bormida, M.S., CCC-SLP
• Ellen Kay Braley, OD

• Emergency Medicine Physician in Carlinville, IL
• Providers in Carlinville, IL by specialty
• Emergency Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2015; 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.