Individual provider Active NPI

Anne Katherine Marshall, PA

  • Physician Assistant
  • Monticello, IL
National Provider Identifier
1922389089
Registry record updated Mar 31, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
085004079 Issued in IL
Practice address
1000 Medical Center Dr
Monticello, IL 61856
Phone
(217) 762-6241
Fax
(217) 762-1702
NPI assigned
Sep 2, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 31, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X 085004079 IL
Physician Assistant 363A00000X 085004079 IL Primary

Addresses

Primary practice location

1000 Medical Center Dr
Monticello, IL 61856

Mailing address

611 W Park St
Fapc
Urbana, IL 61801
Phone (217) 902-5292

Other practice location 1

1802 S Mattis Ave
Champaign, IL 61821-5923
Phone (217) 383-3260

Other practice location 2

1002 Medical Center Dr
Monticello, IL 61856-2116
Phone (217) 762-2518

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20111025000069 IL Practitioner - Physician Assistant 5294908976 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Carle Health Care IncorporatedGroup PAC ID 3577515774, 1,592 clinicians

Practice addresses (Care Compare)

1002 Medical Ctr Dr
Monticello, IL 61856-2116
Phone (217) 762-2518

1701 W Curtis Rd
Champaign, IL 61822-9678
Phone (217) 365-6200

611 W Park St
Urbana, IL 61801-2501
Phone (888) 712-2753

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
085004079ILMDSurgical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Carle Health Care Incorporated Past Accepting new patients

Organizations & group practices 2

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.

Hospital & facility affiliations 4

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": "1314921600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1585612800000",
    "number": "1922389089",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "611 W PARK ST",
            "address_2": "FAPC",
            "city": "URBANA",
            "state": "IL",
            "postal_code": "61801",
            "telephone_number": "217-902-5292"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 MEDICAL CENTER DR",
            "city": "MONTICELLO",
            "state": "IL",
            "postal_code": "61856",
            "telephone_number": "217-762-6241",
            "fax_number": "217-762-1702"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1802 S Mattis Ave",
            "address_purpose": "LOCATION",
            "city": "Champaign",
            "state": "IL",
            "postal_code": "618215923",
            "country_code": "US",
            "telephone_number": "217-383-3260",
            "fax_number": "217-383-4459",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1002 Medical Center Dr",
            "address_purpose": "LOCATION",
            "city": "Monticello",
            "state": "IL",
            "postal_code": "618562116",
            "country_code": "US",
            "telephone_number": "217-762-2518",
            "fax_number": "217-762-5261",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MARSHALL",
        "first_name": "ANNE",
        "middle_name": "KATHERINE",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-09-02",
        "last_updated": "2020-03-31",
        "certification_date": "2020-03-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "IL",
            "license": "085004079",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085004079",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Monticello, IL

Sources for this page

Verify at the official NPI Registry.