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ROBERT ANDREW THAIN MD
NPI 1285737213
Family Medicine in O Fallon, IL

Active since September 06, 2006PECOS EnrolledAccepts Medicare Assignment
94.61/100
CMS Quality Rating
100 SPRINGFIELD CT, O FALLON, IL 62269(618) 632-3565 Get Directions Write a Review

NPPES record last updated: October 20, 2025. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Dec 7, 2023, Aug 24, 2023, Jan 8, 2019 (3 updates tracked since 2019).

About Robert Andrew Thain Md NPPES

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

ROBERT ANDREW THAIN MD (NPI 1285737213) is an individual family medicine provider in O Fallon, Illinois, licensed in Illinois (036-087321) and active in the NPI registry since September 2006. He is enrolled in Medicare PECOS, is affiliated with Hshs St Elizabeth's Hospital, and maintains a secondary practice location in Mattoon.

NPPES Registry Identity

NPI1285737213
Entity TypeIndividualMale
Primary Taxonomy207Q00000X
Provider Legal NameROBERT ANDREW THAINCredential: MD
Location Address100 SPRINGFIELD CTO Fallon, IL 62269-2495
Mailing Address100 Springfield CtO Fallon, IL 62269-2495 · (618) 632-3565
Phone(618) 632-3565
Sole ProprietorNo
Medical School CMSOtherGraduated 1991
Enumeration DateSeptember 6, 2006
Last NPPES UpdateOctober 20, 20253 updates tracked since enumeration
NPPES CertifiedOctober 20, 2025
✔ NPI 1285737213 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
License✔ Licensed in IL · 036-087321
Definition
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
100 SPRINGFIELD CT, O Fallon, IL 62269
Open in Google Maps ↗

Secondary Practice Location 1

Location 1200 Richmond Ave E Ste 1Mattoon, IL 61938-4652 · Phone (217) 234-7000 · Fax (217) 234-7011

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter Health, Ambetter Health of Delaware.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Robert Andrew Thain Md is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID6204854813
PECOS Enrollment IDI20071019000074
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignment

Medicare enrollment records show Robert Thain reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Sarah Bush Lincoln Health Center
52 mi
Skilled Nursing Facility
650 W TAYLOR ST
Vandalia, IL 62471
  • Reassigned Medicare billing, Illinois enrollment
  • 652 clinicians in this Medicare group
NPI 1306959689 (618) 283-1232

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Areas of Expertise CMS Part B claims 5

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more 99214
This is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.
186 services96 patients
New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more 99204
This is a first-time office or outpatient visit lasting between 45-59 minutes. The healthcare provider evaluates your health, discusses your medical history, and may suggest further tests or treatments. It's an opportunity to ask questions and understand your health better.
56 services56 patients
Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more 99213
This is a routine visit for patients who have already been seen by the healthcare provider. During this approximately 20-29 minute appointment, your health status will be evaluated and any necessary treatments or tests will be discussed. It's a chance to address any health concerns you may have.
34 services29 patients
Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit G0439
An annual wellness visit is a yearly appointment with your primary care provider to create or update a personalized prevention plan. This plan helps prevent illness based on your current health and risk factors. It's a subsequent visit, meaning it follows an initial assessment.
15 services15 patients
Transitional care management services for problem of at least moderate complexity 99495
Transitional care management services focus on coordinating and managing your care after you leave the hospital. For moderate complexity problems, this involves managing your medications, arranging further treatments, and ensuring you have the necessary follow-ups.
11 services11 patients

Hospital Affiliations CMS Care Compare 2

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Hshs St Elizabeth's Hospital

Acute Care Hospitals · O Fallon, IL
4/5 CMS rating
OwnershipVoluntary non-profit - Church
CMS Certification Number140187
LocationOne St Elizabeth BoulevardO Fallon, IL 62269 · St. Clair County
Emergency services Birthing friendly

Sarah Bush Lincoln Health Center

Acute Care Hospitals · Mattoon, IL
1/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number140189
Location1000 Health Center Drive P O Box 372Mattoon, IL 61938 · Coles County
Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 62269 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$88.44 typical visit price
range $56.28 – $173.35
Typical copayment $22.11 (range $14.07 – $43.33)
Most-billed visit code 99203
Established Patient
$99.71 typical visit price
range $17.51 – $139.99
Typical copayment $24.92 (range $4.37 – $34.99)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Medicare Quality Performance CMS QPP · MIPS

Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.

94.61/100
MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program
Scored through an Alternative Payment Model
Quality85.17
Promoting Interoperability100
Improvement Activities40

Referred Medical Equipment & Supplies CMS DME claims 19

Durable medical equipment, devices and supplies this provider ordered from DME suppliers for patients, from Medicare fee-for-service claims.

Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips A4253
DME-Other DME · category DE017N
9 suppliers76 claims159 services$5.78 avg. paid by Medicare
Lancets, per box of 100 A4259
DME-Medical/Surgical Supplies · category DA000N
5 suppliers22 claims23 services$1.04 avg. paid by Medicare
Male external catheter, with or without adhesive, disposable, each A4349
DME-Medical/Surgical Supplies · category DA000N
1 supplier12 claims375 services$1.55 avg. paid by Medicare
Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each A4358
DME-Orthotic Devices · category DF000N
1 supplier12 claims24 services$4.79 avg. paid by Medicare
Tubing with integrated heating element for use with positive airway pressure device A4604
DME-Other DME · category DE001N
2 suppliers20 claims20 services$43.95 avg. paid by Medicare
Full face mask used with positive airway pressure device, each A7030
DME-Other DME · category DE001N
3 suppliers11 claims11 services$104.37 avg. paid by Medicare
Dollar amounts are the average Medicare paid the supplier per service. They are not the cost to the patient.

Other Providers at the Same Location NPPES 4

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

DR. KEVIN L PRITCHETT M.D.
Family Medicine
100 SPRINGFIELD CT
O FALLON, IL 62269
St. Clair County (618) 632-3565
B.F. SAKRAN, M.D., P.C.
Family Medicine
100 SPRINGFIELD CT
O FALLON, IL 62269
St. Clair County (618) 632-3565
MRS. VANESSA MARIE STULTS PA-C
Physician Assistant
100 SPRINGFIELD CT
O FALLON, IL 62269
St. Clair County (618) 632-3565
KEVIN L PRITCHETT M.D PC
Family Medicine
100 SPRINGFIELD CT
O FALLON, IL 62269
St. Clair County (618) 632-3565

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Robert Thain's NPI number?

The NPI number for Robert Thain is 1285737213. It was assigned to this individual provider in the NPPES registry on September 6, 2006.

Where is Robert Thain located?

Robert Thain practices at 100 Springfield Ct, O Fallon, IL 62269. The listed phone number is (618) 632-3565.

What is Robert Thain's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Is Robert Thain enrolled in Medicare?

Yes. Robert Thain is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

Which organization bills Medicare for Robert Thain's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Robert Thain reassigns Medicare benefits to Sarah Bush Lincoln Health Center (Vandalia, IL). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Robert Thain's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Robert Thain accept?

Health plans from Ambetter Health and Ambetter Health of Delaware list Robert Thain as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

Is Robert Thain affiliated with any hospitals?

According to CMS data, Robert Thain is affiliated with Hshs St Elizabeth's Hospital and Sarah Bush Lincoln Health Center.

When was this NPI record last updated?

The NPPES record for Robert Thain was last updated on October 20, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 12 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.