STEPHEN ELLEDGE (NPI# 1063829653) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1063829653 |
| Entity Type | Individual |
| Full Name | STEPHEN ELLEDGE |
| Credential | P.A. |
| Practice Address |
310 W Losey St Scott Afb IL 62225 |
| Mailing Address |
310 W Losey St Scott Afb IL 62225-5250 |
| Practice Telephone | 6182567804 |
| Practice Fax Number | 6182567619 |
| Mailing Telephone | 6182567804 |
| Mailing Fax Number | 6182567619 |
| Enumeration Date | 2014-07-16 |
| Last Update Date | 2018-06-13 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
310 W LOSEY ST |
| City | SCOTT AFB |
| State | IL |
| Zip Code | 62225 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205839727 | Toney L Banks | Nurse Anesthetist, Certified Registered | 310 W Losey St, Scott Afb, IL 62225-5250 | 2005-05-30 |
| 1841814852 | Hilary Elizabeth Parsons | Student in an Organized Health Care Education/Training Program | 310 W Losey St, Scott Afb, IL 62225-5250 | 2020-06-04 |
| 1447874722 | Mauranda Nikki Bembry | Social Worker | 310 W Losey St, Scott Afb, IL 62225-5250 | 2020-06-03 |
| 1437778016 | Mark Alan Underhill | Military Health Care Provider | 310 W Losey St, Scott Afb, IL 62225-5250 | 2020-04-13 |
| 1194353276 | Kolin Daniel Cookson | Student in an Organized Health Care Education/Training Program | 310 W Losey St, Scott Afb, IL 62225-5250 | 2020-04-01 |
| 1831723592 | Linh Thuy Truong | Dentist | 310 W Losey St, Scott Afb, IL 62225-5250 | 2020-03-02 |
| 1346890894 | Crystal June Garcia | Military Health Care Provider | 310 W Losey St, Scott Afb, IL 62225-5250 | 2019-09-17 |
| 1740835602 | Andres Alejandro Paredes | Physician Assistant | 310 W Losey St, Scott Afb, IL 62225-5250 | 2019-08-07 |
| 1215580386 | Ryan Taylor Blalock | Military Health Care Provider | 310 W Losey St, Scott Afb, IL 62225-5250 | 2019-07-18 |
| 1063975001 | Collin Schroeder | Military Health Care Provider | 310 W Losey St, Scott Afb, IL 62225-5250 | 2019-04-08 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861011645 | Cheryl D Jones | Registered Nurse | 375th Mdg, 310 W. Losey Street, Scott Afb, IL 62225 | 2020-04-13 |
| 1649836123 | Benjamin Truong | Student in an Organized Health Care Education/Training Program | Scott Air Force Base, 307 West Losey Street Building #1535, Apo, AA 62225 | 2019-05-10 |
| 1558925669 | Brian Ng | Student in an Organized Health Care Education/Training Program | South Drive, Scott Afb, Illinois, Apo, AA 62225 | 2019-04-24 |
| 1841853710 | Lance Scott Mcgavin | Student in an Organized Health Care Education/Training Program | 307 West Losey Street., Building #1535, Scott Afb, IL 62225 | 2019-04-17 |
| 1629503180 | Joshua Bryce Kessack | General Practice | 375 Amds, 310 Losey St, Scott Afb, IL 62225 | 2017-04-21 |
| 1265988059 | Jennifer Nicole Laurence | Dentist | 703 Seibert Rd Ste 5, Scott Afb, IL 62225 | 2016-08-31 |
| 1578940755 | Usv Optical Inc | Eyewear Supplier (Equipment, not the service) | 207 W. Winters St., Bldg 1981, Scott Afb, IL 62225 | 2015-04-27 |
| 1891193652 | Diana Meyer | Social Worker | Scott Afb, Apo, AA 62225 | 2014-12-10 |
| 1801210273 | Robie Victoria Hughes | Registered Nurse | 310 W Losey Street, Scott Air Force Base, IL 62225 | 2014-02-06 |
| 1487998746 | Melissa Dawn Goff | Military Health Care Provider | 310 West. Losey Street, Scott Afb, IL 62225 | 2012-11-26 |
| Find all providers in zip 62225 | ||||
| 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 |
|---|---|---|---|---|
| 1740835602 | Andres Alejandro Paredes | Physician Assistant | 310 W Losey St, Scott Afb, IL 62225-5250 | 2019-08-07 |
| 1609344274 | Stephen Martin Gilbert | Physician Assistant | 310 W Losey St, Scott Afb, IL 62225-5250 | 2018-11-13 |
| 1346651734 | Dustin Billy Gleave | Physician Assistant | 310 W Losey St, Scott Afb, IL 62225-5250 | 2014-05-19 |
| 1790762557 | Deborah Leigh Henry | Physician Assistant | 310 W Losey St, Scott Afb, IL 62225-5250 | 2005-12-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063010924 | Mckenzie Youngblood | Physician Assistant | 28653 Wren Ln, Jerseyville, IL 62052-6501 | 2020-10-13 |
| 1548877400 | Shawn Milhauser | Physician Assistant | 1014 N Mill St, Pontiac, IL 61764-1332 | 2020-09-25 |
| 1982210654 | Brittany Michelle Weber | Physician Assistant | 525 E Congress Pkwy Ste 200, Crystal Lake, IL 60014-6271 | 2020-09-18 |
| 1003421603 | Logan M Barkley | Physician Assistant | 2560 24th St Ste 201, Rock Island, IL 61201-5390 | 2020-09-10 |
| 1336753342 | Navneet Kaur Bamrah | Physician Assistant | 11316 S Highland Dr, Plainfield, IL 60585-1581 | 2020-09-07 |
| 1306450424 | Annie Mannancheril | Physician Assistant | 9114 Waukegan Rd, Morton Grove, IL 60053-2135 | 2020-09-04 |
| 1508470709 | Bryan Ying Wong | Physician Assistant | 3420 S Morgan St Apt 2e, Chicago, IL 60608-6904 | 2020-09-04 |
| 1386256402 | Emma Schmidt | Physician Assistant | 20 Haverton Ct, Streamwood, IL 60107-1682 | 2020-08-19 |
| 1063024388 | Alyson Dyck | Physician Assistant | 2540 Health Services, Ssb Student Services Building, Normal, IL 61790-2540 | 2020-08-18 |
| 1649882192 | Anna Marie Phillips | Physician Assistant | 5337 Main St, Skokie, IL 60077-2029 | 2020-08-17 |
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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.