Active NPI
Rebecca Minnis, PA-C
- Physician Assistant
- Carbondale, IL
National Provider Identifier
1922249275
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 085.003413
- Practice address
- 305 W Jackson St
Suite 102
Carbondale, IL 62901-1474 - Phone
- (618) 351-9300
- NPI assigned
- Mar 17, 2009
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 085.003413 | IL | Primary |
Addresses
Primary practice location
305 W Jackson St
Suite 102
Carbondale, IL 62901-1474
Mailing address
305 W Jackson St
Suite 102
Carbondale, IL 62901-1474
Phone (618) 351-9300
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 |
|---|---|---|---|
| 085.003413 | IL | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1237248000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1237248000000",
"number": "1922249275",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "305 W JACKSON ST",
"address_2": "SUITE 102",
"city": "CARBONDALE",
"state": "IL",
"postal_code": "629011474",
"telephone_number": "618-351-9300"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "305 W JACKSON ST",
"address_2": "SUITE 102",
"city": "CARBONDALE",
"state": "IL",
"postal_code": "629011474",
"telephone_number": "618-351-9300"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MINNIS",
"first_name": "REBECCA",
"name_prefix": "Mrs.",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-03-17",
"last_updated": "2009-03-17",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "IL",
"license": "085.003413",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Carbondale, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.