PRINCETON EMERGENCY SERVICES, LLC (NPI# 1134187875) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1134187875 |
| Entity Type | Organization |
| Organization Name | PRINCETON EMERGENCY SERVICES, LLC |
| Practice Address |
530 Park Ave E Princeton IL 61356-3901 |
| Mailing Address |
Po Box 758733 Baltimore MD 21275-0001 |
| Practice Telephone | 8158752811 |
| Practice Fax Number | 9048051302 |
| Mailing Telephone | 9048051300 |
| Mailing Fax Number | 9048051302 |
| Enumeration Date | 2006-05-03 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | EUGENE DAUCHERT (CEO/PRESIDENT) |
| Authorized Official Telephone | 9197684392 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| X | 363A00000X | Physician Assistant | Physician Assistants & Advanced Practice Nursing Providers | ||
| X | 207P00000X | Emergency Medicine | Allopathic & Osteopathic Physicians | ||
| X | 363L00000X | Nurse Practitioner | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | RAIL ROAD MEDICARE | DC8696 | 01 |
| IL | BLUE CROSS & BLUE SHIELD | 0623850 | 01 |
| Street Address |
530 PARK AVE E |
| City | PRINCETON |
| State | IL |
| Zip Code | 61356-3901 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124021308 | Julia Rackley Perry Memorial Hospital | General Acute Care Hospital | 530 Park Ave E, Princeton, IL 61356-3901 | 2005-05-23 |
| 1427529577 | Ashley Kannenberg | Dietitian, Registered | 530 Park Ave E, Princeton, IL 61356-2598 | 2018-12-16 |
| 1689126799 | Jo A Muller | Nurse Practitioner | 530 Park Ave E, Ste 207, Princeton, IL 61356-3901 | 2016-10-25 |
| 1578940524 | Jennifer Hoffman | Nurse Practitioner | 530 Park Ave E, Princeton, IL 61356-3901 | 2015-04-29 |
| 1114326956 | Ketan R Patel | Internal Medicine | 530 Park Ave E, Suite 101, Princeton, IL 61356-3901 | 2014-08-18 |
| 1922411602 | Julia Rackley Perry Memorial Hospital | Clinic/Center | 530 Park Ave E, Princeton, IL 61356-3901 | 2014-06-10 |
| 1942551312 | Jenny Gaworski | Nurse Practitioner | 530 Park Ave E, Princeton, IL 61356-3901 | 2012-09-26 |
| 1619231719 | Victoria Jeannine Anderson | Physical Therapy Assistant | 530 Park Ave E, Princeton, IL 61356-2598 | 2012-07-03 |
| 1710241286 | Jacquelyn Johnson | Occupational Therapist | 530 Park Ave E, Princeton, IL 61356-3901 | 2012-06-29 |
| 1023372869 | Debra K Austin | Physical Therapist | 530 Park Ave E, Princeton, IL 61356-2598 | 2012-06-26 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548698558 | Shelley Gorenz | Counselor | 1009 S. Main St., Princeton, IL 61356 | 2013-10-30 |
| 1780016626 | Jennifer Phillips | Pharmacist | 610 N. Main St., Princeton, IL 61356 | 2013-08-02 |
| 1477848521 | Princeton Prompt Care LLC | Clinic/Center | 2128 North Main Street, Princeton, IL 61356 | 2011-06-16 |
| 1306014196 | Lifefit Physical Rehab, Ltd. | Clinic/Center | 1225 N. Sixth St., Princeton, IL 61356 | 2008-02-14 |
| 1568669778 | Hawthorne Inn Supportive Living Facility | Assisted Living Facility | 136 N. Sixth St., Princeton, IL 61356 | 2007-06-29 |
| 1720209240 | Michelle Lee Mortensen | Music Therapist | 816 S. First St., Princeton, IL 61356 | 2007-05-01 |
| 1073733465 | Jarred Allen Farrell | Chiropractor | 682 East Peru Street, Princeton, IL 61356 | 2007-04-26 |
| 1952488397 | Donald R Marion | Optometrist | 2 Park Avenue West, Princeton, IL 61356 | 2006-11-01 |
| 1427138247 | Bruce Waldo Shriver | Dentist | 422 E Peru St, Princeton, IL 61356 | 2006-10-16 |
| 1871689612 | Jason A Monroe | Dentist | 334 Backbone Rd East, Princeton, IL 61356 | 2006-10-05 |
| Find all providers in zip 61356 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205464724 | Shraddha S Patel | Physician Assistant | 29 Goldstar Dr, Princeton, NJ 08540-8578 | 2020-03-30 |
| 1538702154 | Sahara Stanley | Physician Assistant | 104 Mahood Ave, Princeton, WV 24740-2617 | 2019-10-27 |
| 1205210853 | Homer K Lester | Physician Assistant | 112 12th St, Princeton, WV 24740-2312 | 2015-07-14 |
| 1285039420 | Deaconess Clinic, Inc. | Physician Assistant | 1414 W Broadway St, Princeton, IN 47670-1142 | 2014-10-30 |
| 1154738839 | Brittany Hope Jewell | Physician Assistant | 508 New Hope Rd Ste 102, Princeton, WV 24740-2265 | 2014-07-15 |
| 1861638561 | Adeyemi Babatunde Williams | Physician Assistant | 60 Hoover Ave, Princeton, NJ 08540-4639 | 2008-12-30 |
| 1184793556 | Joseph Harold Thornton | Physician Assistant | Princeton University Health, Mccosh Health Center, Princeton, NJ 08544-0001 | 2006-11-07 |
| 1104919828 | Leah D Petrunger | Physician Assistant | 150 Misty Lane, Princeton, WV 24740 | 2006-10-02 |
| 1437756350 | Olivia N Dudley | Physician Assistant | 325 Princeton Ave, Princeton, NJ 08540-1617 | 2020-10-04 |
| 1952919417 | Madelyn L Schwartz | Physician Assistant | 325 Princeton Ave, Princeton, NJ 08540-1617 | 2020-07-21 |
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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.