MR. RALPH DOUGLAS SPAFFORD (NPI# 1043446008) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1043446008 |
| Entity Type | Individual |
| Full Name | MR. RALPH DOUGLAS SPAFFORD |
| Credential | P.A.-C |
| Practice Address |
916 Talon Dr Suite 102 O Fallon IL 62269-1848 |
| Practice Telephone | 6186288211 |
| Practice Fax Number | 6186280883 |
| Mailing Telephone | 6186288211 |
| Mailing Fax Number | 6186280883 |
| Enumeration Date | 2009-06-04 |
| Last Update Date | 2012-03-14 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363AM0700X |
Physician Assistant Specialization: Medical |
385000318 | IL | Physician Assistants & Advanced Practice Nursing Providers |
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
117199 | MO | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | CIGNA | 1811940893 | 01 |
| IL | UHC | 1811940893 | 01 |
| IL | AETNA | 1811940893 | 01 |
| IL | BCBS | 1811940893 | 01 |
| IL | TRICARE | 1811940893 | 01 |
| IL | HEALTHLINK | 1811940893 | 01 |
| Street Address |
916 TALON DR SUITE 102 |
| City | O FALLON |
| State | IL |
| Zip Code | 62269-1848 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235135617 | John Steve Vick | Chiropractor | 916 Talon Dr, Ste 102, O Fallon, IL 62269-1848 | 2005-06-22 |
| 1194377325 | Collin Magilligan | Nurse Practitioner | 916 Talon Dr, O Fallon, IL 62269-1848 | 2019-07-09 |
| 1972057420 | Elsa K Raymond | Nurse Practitioner | 916 Talon Dr, Suite 102, O Fallon, IL 62269-1848 | 2016-08-12 |
| 1225495286 | Kristen Lyn Pitts | Physical Therapist | 916 Talon Dr, O Fallon, IL 62269-1848 | 2016-01-21 |
| 1770949125 | Patricia J Relleke | Nurse Practitioner | 916 Talon Dr, Suite 102, O Fallon, IL 62269-1848 | 2016-01-14 |
| 1376938225 | Apg Medical Laboratory | Clinical Medical Laboratory | 916 Talon Dr, Suite 102, O Fallon, IL 62269-1848 | 2015-03-30 |
| 1407279623 | Associated Physicians Group | Chiropractor | 916 Talon Dr, Suite 102, O Fallon, IL 62269-1848 | 2014-01-23 |
| 1285064329 | Dme Edge LLC | Durable Medical Equipment & Medical Supplies | 916 Talon Dr, Suite B, O Fallon, IL 62269-1848 | 2013-11-26 |
| 1881979623 | Maria Louise Cunningham | Physical Medicine & Rehabilitation | 916 Talon Dr, Suite 102, O Fallon, IL 62269-1848 | 2011-10-12 |
| 1104071067 | Jessica Ann Zimmerman | Physical Therapist | 916 Talon Dr, Suite 102, O Fallon, IL 62269-1848 | 2008-11-19 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326648155 | Kayla Revermann | Pharmacist | 1350 W Us Highway 50, Pharmacy, O Fallon, IL 62269 | 2020-10-30 |
| 1942814272 | Ashley Monique Gibson | Behavior Technician | Eagle Center, Ste 10, Ofallon, IL 62269 | 2020-09-03 |
| 1013533819 | Michelle Denise Voudrie | Registered Nurse | 321 Regency Park, O'fallon, IL 62269 | 2020-06-18 |
| 1598398455 | Washington University Physicians In Illinois - Cancer Center Pharmacy | Pharmacy | 1418 Cross Street, Suite 180, Shiloh, IL 62269 | 2020-02-19 |
| 1962063800 | Gerald Paskert | Pharmacist | 122 W. State St., O'fallon, IL 62269 | 2019-06-21 |
| 1780144808 | Bonnie Jean Lampe | Physical Therapy Assistant | 316 Donna Dr, O'fallon, IL 62269 | 2019-03-24 |
| 1134633993 | Latisha Smith | Psychologist | 600 S. Smiley St., O'fallon, IL 62269 | 2017-11-30 |
| 1619407210 | Brenna M Thomas | Registered Nurse | 1310 Engle Ct, O'fallon, IL 62269 | 2017-06-15 |
| 1881135622 | Pc Associates, LLC | Family Medicine | 800 East Highway 50, O'fallon, IL 62269 | 2017-03-13 |
| 1700230539 | Jennifer Farrell | Family Medicine | 3 St. Elizabeth's Blvd, Ste. 4000, O'fallon, IL 62269 | 2016-04-18 |
| Find all providers in zip 62269 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700228350 | Jennifer Lynn Swofford | Physician Assistant | 7136 S Outer Road 364, O Fallon, MO 63368-7756 | 2013-07-24 |
| 1114299419 | Lucy Elliott | Physician Assistant | 310 N 7 Hills Rd, O Fallon, IL 62269-4111 | 2012-02-01 |
| 1285729970 | Julie D. Medlin | Physician Assistant | 7136 S Outer Road 364, O Fallon, MO 63368-7756 | 2006-10-04 |
| 1053390237 | Gregory Scott Churchill | Physician Assistant | 310 N 7 Hills Rd, O Fallon, IL 62269-4111 | 2006-01-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831707298 | Eliza Ballen | Physician Assistant | 335 Sylvan Rd, Lake Bluff, IL 60044-2562 | 2020-07-21 |
| 1477177947 | Rybecca Janovyak | Physician Assistant | 14432 High Rd, Lockport, IL 60441-9402 | 2020-06-01 |
| 1518591759 | Julie Jenkot | Physician Assistant | 333 N Michigan Ave Fl 14, Chicago, IL 60601-3901 | 2020-02-26 |
| 1801429873 | Hinjal D Jha | Physician Assistant | 22285 N Pepper Rd Ste 409, Lake Barrington, IL 60010-2542 | 2020-02-19 |
| 1770120222 | Alvina Shaikh | Physician Assistant | 4009 Warren Ave, Bellwood, IL 60104-2066 | 2019-12-03 |
| 1457997561 | Jasleen Mohini Singh | Physician Assistant | 1645a W School Street, Suite A, Clinic Entrance, Chicago, IL 60657 | 2019-11-24 |
| 1538705272 | Bethany Mae Frisby | Physician Assistant | 8630 W Golf Rd, Niles, IL 60714-5600 | 2019-11-18 |
| 1134761984 | Ella-marie Rakowski | Physician Assistant | 25 Acorn Dr, Hawthorn Woods, IL 60047-7407 | 2019-10-14 |
| 1467001859 | Timothy Omotayo Adesanya | Physician Assistant | Graham Correctional Center, 12078 Illinois Rte 185, Hilliboro, IL 62049 | 2019-09-09 |
| 1518514066 | Victoria Moore | Physician Assistant | 979 W Main St, West Dundee, IL 60118-2088 | 2019-08-20 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.