NPIMap

Individual provider Active NPI

Brennan Malham, PA-C

  • Physician Assistant
  • Springfield, IL
National Provider Identifier
1942758081
Registry record updated Nov 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
085.005974 Issued in IL
Practice address
1301 S Koke Mill Rd
Springfield, IL 62711-9252
Phone
(217) 547-9100
Fax
(217) 547-9236
NPI assigned
Sep 19, 2016
Last updated
Nov 22, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 22, 2024

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 085.005974 IL Primary

Addresses

Primary practice location

1301 S Koke Mill Rd
Springfield, IL 62711-9252

Mailing address

1301 S Koke Mill Rd
Springfield, IL 62711-9252
Phone (217) 547-9100

Other practice location 1

1 Memorial Dr
Alton, IL 62002-6722
Phone (618) 463-7474

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
I20170314000361 IL Practitioner - Physician Assistant 3779868781 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Orthopaedic Center of IlGroup PAC ID 0143299628, 29 clinicians

Practice addresses (Care Compare)

1301 S Koke Mill Rd
Springfield, IL 62711-9252
Phone (217) 547-9100

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
63.56 of 100Reported as group
Quality
57.12
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
085.005974ILMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Toofan Medical Holdings, LTD. CurrentSince Aug 1, 2018 Accepting new patients
Toofan Medical Holdings, LTD CurrentSince Aug 1, 2018 Accepting new patients
Orthopaedic Center of Illinois Past Accepting new patients

Locations

1001 Avenue of Mid America
Ste 4
Effingham, IL 62401
Phone (217) 994-9301

Interoperability endpoints

  • Direct secure messaging: brennanmalham@oci.allscriptsdirect.net

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 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": "1474243200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1732233600000",
    "number": "1942758081",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1301 S KOKE MILL RD",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627119252",
            "telephone_number": "217-547-9100",
            "fax_number": "217-547-9236"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1301 S KOKE MILL RD",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627119252",
            "telephone_number": "217-547-9100",
            "fax_number": "217-547-9236"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1 Memorial Dr",
            "address_purpose": "LOCATION",
            "city": "Alton",
            "state": "IL",
            "postal_code": "620026722",
            "country_code": "US",
            "telephone_number": "618-463-7474",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MALHAM",
        "first_name": "BRENNAN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-09-19",
        "last_updated": "2024-11-22",
        "certification_date": "2024-11-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085.005974",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Springfield, IL

Sources for this page

Verify at the official NPI Registry.