Lillian G Shively, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

085007743 Issued in IL

Practice address

270 Maple Summit Rd
McDow BLDG
Jerseyville, IL 62052

Phone

(618) 498-7108

Fax

(618) 498-7919

NPI assigned

Dec 3, 2020

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

Other names 1

• Lillian G Tepen Former name

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

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Jersey Community HospitalGroup PAC ID 4587650445, 62 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Jersey Community Hospital Hospital, Jerseyville, IL, CCN 140059

Merit-based Incentive Payment System (MIPS)

Final score

91.05 of 100Reported as apm

Quality

72.1

Promoting interoperability

100

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

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.

• Jersey Community Hospital

  • Personal Emergency Response Attendant
  • Jerseyville, IL
  • NPI 1780609925
  Medicare reassignment Care Compare group
• Jersey Community Hospital

  • Rural Health Clinic/Center
  • Jerseyville, IL
  • NPI 1659750818
  NPD
• Jersey Community Hospital

  • Rural Health Clinic/Center
  • Jerseyville, IL
  • NPI 1700423696
  NPD

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

• Jersey Community Hospital

  • General Acute Care Hospital
  • Jerseyville, IL
  • NPI 1184630519
  Care Compare affiliation

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

{
    "created_epoch": "1606953600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731456000000",
    "number": "1972108280",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "390 MAPLE SUMMIT RD",
            "city": "JERSEYVILLE",
            "state": "IL",
            "postal_code": "620522000",
            "telephone_number": "618-498-7518",
            "fax_number": "618-498-3052"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "270 MAPLE SUMMIT RD",
            "address_2": "MCDOW BLDG",
            "city": "JERSEYVILLE",
            "state": "IL",
            "postal_code": "62052",
            "telephone_number": "618-498-7108",
            "fax_number": "618-498-7919"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "903 S State St",
            "address_purpose": "LOCATION",
            "city": "Jerseyville",
            "state": "IL",
            "postal_code": "620522344",
            "country_code": "US",
            "telephone_number": "618-639-9255",
            "fax_number": "618-639-8100",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "390 Maple Summit Rd",
            "address_2": "Illini Bldg",
            "address_purpose": "LOCATION",
            "city": "Jerseyville",
            "state": "IL",
            "postal_code": "62052",
            "country_code": "US",
            "telephone_number": "618-498-2101",
            "fax_number": "618-498-8153",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHIVELY",
        "first_name": "LILLIAN",
        "middle_name": "G",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-12-03",
        "last_updated": "2024-11-13",
        "certification_date": "2024-11-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085007743",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "lshively@jch.cernerdirect.com",
            "affiliation": "N",
            "endpointDescription": "HIE JERSEY",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "270 Maple Summit Rd",
            "address_2": "McDow Bldg",
            "city": "Jerseyville",
            "state": "IL",
            "country_code": "US",
            "postal_code": "62052",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "lshively@jch.cernerdirect.com",
            "affiliation": "N",
            "endpointDescription": "HIE JERSEY",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "903 S State St",
            "city": "Jerseyville",
            "state": "IL",
            "country_code": "US",
            "postal_code": "620522344",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "lshively@jch.cernerdirect.com",
            "affiliation": "N",
            "endpointDescription": "HIE JERSEY",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "390 Maple Summit Rd",
            "address_2": "Illini Bldg",
            "city": "Jerseyville",
            "state": "IL",
            "country_code": "US",
            "postal_code": "62052",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "LILLIAN",
            "last_name": "TEPEN",
            "middle_name": "G",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 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.