Jenifer Marie Chambless, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

085001864 Issued in IL

Practice address

300 W Oak St
Carbondale, IL 62901-1400

Phone

(618) 536-6621

Fax

(618) 453-1102

NPI assigned

Jan 31, 2007

Last updated

Jul 29, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Electronic endpoints 3

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

Specialty

Physician Assistant

Education

University of Nebraska College of Medicine, 2002

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Board of Trustees of Southern Illinois UniversityGroup PAC ID 4486667888, 139 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Memorial Hospital of Carbondale Hospital, Carbondale, IL, CCN 140164
• St Joseph Memorial Hospital Hospital, Murphysboro, IL, CCN 141334

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jchambless15551@sih.direct-ci.com
• Direct secure messaging: jeniferchambless@siusm.allscriptsdirect.net

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.

• Board of Trustees of Southern Illinois University

  dba Siu Center for Family Medicine

  • Primary Care Clinic/Center
  • Springfield, IL
  • NPI 1396097960
  Medicare reassignment Care Compare group NPD
• Siu Physicians & Surgeons, Inc

  dba SIU HealthCare

  • Endocrinology, Diabetes & Metabolism Physician
  • Springfield, IL
  • NPI 1558385989
  Medicare reassignment NPD
• Southern Illinois Hospital Services

  dba Herrin Hospital

  • General Acute Care Hospital
  • Herrin, IL
  • NPI 1528158573
  Medicare reassignment
• Board of Trustees of Southern Illinois University

  dba Carbondale Care A Van

  • Rural Health Clinic/Center
  • Carbondale, IL
  • NPI 1215978127
  NPD
• Board of Trustees of Southern Illinois University

  dba SIU Center for Family Medicine - Care-A-Van

  • Federally Qualified Health Center (FQHC)
  • Carbondale, IL
  • NPI 1568210425
  NPD
• Siu Physicians & Surgeons, Inc

  • Durable Medical Equipment & Medical Supplies
  • Springfield, IL
  • NPI 1164055976
  NPD
• Southern Illinois Hospital Services

  dba West Frankfort Family Medicine

  • Family Medicine Physician
  • West Frankfort, IL
  • NPI 1154408581
  NPD
• Southern Illinois Hospital Services

  dba St. Joseph Memorial Hospital

  • Medicare Defined Swing Bed Hospital Unit
  • Murphysboro, IL
  • NPI 1639595036
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Southern Illinois Hospital Services

  dba Memorial Hospital of Carbondale

  • General Acute Care Hospital
  • Carbondale, IL
  • NPI 1093801797
  Care Compare affiliation
• Southern Illinois Hospital Services

  dba St. Joseph Memorial Hospital

  • Critical Access Hospital
  • Murphysboro, IL
  • NPI 1356435135
  Care Compare affiliation

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

{
    "created_epoch": "1170201600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722211200000",
    "number": "1962549790",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 19639",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627949639",
            "telephone_number": "217-545-8000",
            "fax_number": "844-470-2486"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 W OAK ST",
            "city": "CARBONDALE",
            "state": "IL",
            "postal_code": "629011400",
            "telephone_number": "618-536-6621",
            "fax_number": "618-453-1102"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "305 W Jackson St",
            "address_2": "SUITE 200",
            "address_purpose": "LOCATION",
            "city": "Carbondale",
            "state": "IL",
            "postal_code": "629011474",
            "country_code": "US",
            "telephone_number": "618-453-3777",
            "fax_number": "618-453-1102",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "300 W Oak St Ste 100",
            "address_purpose": "LOCATION",
            "city": "Carbondale",
            "state": "IL",
            "postal_code": "629011496",
            "country_code": "US",
            "telephone_number": "618-536-6621",
            "fax_number": "618-453-1102",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2553 Ken Gray Blvd",
            "address_purpose": "LOCATION",
            "city": "West Frankfort",
            "state": "IL",
            "postal_code": "628964174",
            "country_code": "US",
            "telephone_number": "618-932-3937",
            "fax_number": "618-932-2734",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CHAMBLESS",
        "first_name": "JENIFER",
        "middle_name": "MARIE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-31",
        "last_updated": "2024-07-29",
        "certification_date": "2024-07-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "IL",
            "license": "085-001864",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085001864",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jeniferchambless@siusm.allscriptsdirect.net",
            "affiliation": "N",
            "address_1": "305 W Jackson St",
            "address_2": "SUITE 200",
            "city": "Carbondale",
            "state": "IL",
            "country_code": "US",
            "postal_code": "629011474",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jchambless15551@sih.direct-ci.com",
            "affiliation": "N",
            "address_1": "2553 Ken Gray Blvd",
            "city": "West Frankfort",
            "state": "IL",
            "country_code": "US",
            "postal_code": "628964174",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jchambless15551@sih.direct-ci.com",
            "affiliation": "N",
            "address_1": "305 W Jackson St",
            "address_2": "SUITE 200",
            "city": "Carbondale",
            "state": "IL",
            "country_code": "US",
            "postal_code": "629011474",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Stephanie Marie Chambers-Baltz, PHD, LP
• Kyle Michael Chamness, PTA
• Laura E Chandler, MS/CCC-SLP
• Rakesh Chandra, MD
• Dongwoo John Chang, M.D.
• Hark Chang, M.D.

• Physician Assistant in Carbondale, IL
• Providers in Carbondale, 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 29, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.