Jacqueline Ann Coffman, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

085003642 Issued in IL

Practice address

2200 S Main St
Paris, IL 61944-2966

Phone

(217) 463-4340

Fax

(217) 463-4342

NPI assigned

Oct 28, 2009

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: jacqueline.coffman.1@14940.direct.athenahealth.com

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 & Medical Foundation of Paris, Inc.

  • Clinic/Center
  • Paris, IL
  • NPI 1629280367
  NPD (past)

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

{
    "created_epoch": "1256688000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1942536883",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "501 LAKE LAND BLVD",
            "address_2": "SUITE 202, SYSTEM PRACTICES",
            "city": "MATTOON",
            "state": "IL",
            "postal_code": "619385283",
            "telephone_number": "217-258-3370",
            "fax_number": "217-258-3379"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2200 S MAIN ST",
            "city": "PARIS",
            "state": "IL",
            "postal_code": "619442966",
            "telephone_number": "217-463-4340",
            "fax_number": "217-463-4342"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COFFMAN",
        "first_name": "JACQUELINE",
        "middle_name": "ANN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-10-28",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085003642",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physician Assistant in Paris, IL
• Providers in Paris, IL by specialty
• Physician Assistant in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.