LOGAN PRIMARY CARE
NPI 1194913541
Physician Assistant in Herrin, IL

Q: What is Logan Primary Care's NPI number?

The NPI number for Logan Primary Care is 1194913541. It was assigned to this organization in the NPPES registry on October 11, 2007.

Q: What is Logan Primary Care's specialty?

The primary specialty registered for this NPI is Physician Assistant with taxonomy code 363A00000X.

Active since October 11, 2007CLIA 14D0436594 · Waiver

405 RUSHING DR, HERRIN, IL 62948(618) 993-3300(618) 997-6626 Get Directions Write a Review

NPPES record last updated: October 11, 2007. Verified against the NPPES registry weekly; last sync: August 02, 2026.

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About Logan Primary Care NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

LOGAN PRIMARY CARE (NPI 1194913541) is a healthcare organization registered as a physician assistant in Herrin, Illinois and active in the NPI registry since October 2007. The organization holds a CLIA Waiver certificate valid through March 28, 2027 and lists Tara Deaton, Administrator, as its authorized official.

NPPES Registry Identity

NPI1194913541

Entity TypeOrganization

Primary Taxonomy363A00000X

Legal Business NameLOGAN PRIMARY CARE

Location Address405 RUSHING DRHerrin, IL 62948-3730

Mailing Address405 Rushing DrHerrin, IL 62948-3730 · (618) 993-3300 · Fax (618) 997-6626

Phone(618) 993-3300

Fax(618) 997-6626

Organization SubpartNo

Authorized OfficialTara DeatonAdministrator · (618) 993-3300

Enumeration DateOctober 11, 2007

✔ NPI 1194913541 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician AssistantPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363A00000X

License✔ Licensed in IL · 85003043

Definition

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.

405 RUSHING DR, Herrin, IL 62948

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Other Identifiers 7

OtherP00166778IL · Railroad Medicare

Medicare UPIN4499697IL

Other094621IL · Health Alliance

Medicare OSCAR/certification336570IL

Other10019630IL · Blue Cross Blue Shield

Other657869IL · Healthlink

Medicaid143870IL

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 14D0436594

Logan Primary Care Southern Illinois Medical Services · Herrin, IL

Active · expires Mar 28, 2027

CLIA Number14D0436594

Laboratory TypeRural Health Clinic

Certificate Effective DateMarch 29, 2025

Certificate Expiration DateMarch 28, 2027

Laboratory DirectorMark D. Korte

Laboratory Phone(618) 993-3300

Laboratory LocationLogan Primary Care Southern Illinois Medical Services405 Rushing Dr, Herrin, IL 62948

CLIA data matches this NPI record on: Address Name Phone

This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

KRISTIN FRANCIS LCSW

Social Worker (Clinical)