NPIMap

Individual provider Active NPI

Melissa J Gauthier, PA C

  • Physician Assistant
  • Eldorado, IL
National Provider Identifier
1902861164
Registry record updated Apr 22, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
085.000899 Issued in IL
Practice address
1306 Maple St
Eldorado, IL 62930-1662
Phone
(618) 273-3361
Fax
(618) 297-9669
NPI assigned
Apr 19, 2006
Last updated
Apr 22, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 22, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 085.000899 IL Primary

Addresses

Primary practice location

1306 Maple St
Eldorado, IL 62930-1662

Mailing address

1306 Maple St
Eldorado, IL 62930-1662
Phone (618) 273-3361

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
I20060518000014 IL Practitioner - Physician Assistant 2466463971 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1300 US Hwy 45 N
Eldorado, IL 62930-3765
Phone (618) 297-9660

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
91.05 of 100Reported as apm
Quality
72.1
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
085.000899ILMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Ferrell Hospital Community Foundation Family Medicine CurrentSince Nov 4, 2016 Accepting new patients
Ferrell Hospital Community Foundation CurrentSince Nov 4, 2016 Accepting new patients
Ferrell Hospital Community Foundation CurrentSince Nov 4, 2016 Accepting new patients
Ferrell Hospital Community Foundation Past Accepting new patients

Locations

1201 Pine St
Eldorado, IL 62930
Phone (618) 273-3361

1306 Maple St
Eldorado, IL 62930
Phone (618) 273-2360

250 Small St
Harrisburg, IL 62946
Phone (618) 252-4000

Interoperability endpoints

  • Direct secure messaging: mgauthier74003@direct.deaconess.com

Organizations & group practices 5

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": "1145404800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1650585600000",
    "number": "1902861164",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1306 MAPLE ST",
            "city": "ELDORADO",
            "state": "IL",
            "postal_code": "629301662",
            "telephone_number": "618-273-3361",
            "fax_number": "618-297-9669"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1306 MAPLE ST",
            "city": "ELDORADO",
            "state": "IL",
            "postal_code": "629301662",
            "telephone_number": "618-273-3361",
            "fax_number": "618-297-9669"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GAUTHIER",
        "first_name": "MELISSA",
        "middle_name": "J",
        "credential": "PA C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-04-19",
        "last_updated": "2022-04-22",
        "certification_date": "2022-04-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085.000899",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Eldorado, IL

Sources for this page

Verify at the official NPI Registry.