NPIMap

Organization Active NPI

Logan Primary Care

  • Medical Physician Assistant
  • Herrin, IL
National Provider Identifier
1992951123
Registry record updated Aug 7, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
085-003043 Issued in IL
Legal business name
LOGAN PRIMARY CARE
Practice address
405 Rushing Dr
Herrin, IL 62948-3730
Phone
(618) 993-3300
Fax
(618) 993-0262
NPI assigned
Aug 7, 2008
Last updated
Aug 7, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 7, 2008

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

Authorized official

Name
Micah Oakley, PA-CNPI 1912163189
Title
Physician Assistant
Phone
(618) 993-3300

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363AM0700X 085-003043 IL Primary

Addresses

Primary practice location

405 Rushing Dr
Herrin, IL 62948-3730

Mailing address

405 Rushing Dr
Herrin, IL 62948-3730
Phone (618) 993-3300

Other identifiers 6

IdentifierTypeStateIssuer
080077375OtherILRAILROAD MEDICARE
033308OtherILHEALTHLINK
10019630OtherILBLUE CROSS BLUE SHIELD
143870MedicaidIL
657869OtherILHEALTHLINK
033308OtherILHEALTH ALLIANCE

National Provider Directory

National Provider Directory
Tax ID family
Logan Primary Care5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1218067200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1218067200000",
    "number": "1992951123",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "405 RUSHING DR",
            "city": "HERRIN",
            "state": "IL",
            "postal_code": "629483730",
            "telephone_number": "618-993-3300",
            "fax_number": "618-993-0262"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "405 RUSHING DR",
            "city": "HERRIN",
            "state": "IL",
            "postal_code": "629483730",
            "telephone_number": "618-993-3300",
            "fax_number": "618-993-0262"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LOGAN PRIMARY CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-08-07",
        "last_updated": "2008-08-07",
        "status": "A",
        "authorized_official_last_name": "OAKLEY",
        "authorized_official_first_name": "MICAH",
        "authorized_official_title_or_position": "PHYSICIAN ASSISTANT",
        "authorized_official_telephone_number": "618-993-3300",
        "authorized_official_credential": "PA-C"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant, Medical",
            "state": "IL",
            "license": "085-003043",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "080077375",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHLINK",
            "identifier": "033308",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "10019630",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "143870",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHLINK",
            "identifier": "657869",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH ALLIANCE",
            "identifier": "033308",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Herrin, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2008; 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.