DR. JOHN P. OPILKA D.O.
NPI 1497715056
Family Medicine in Altamont, IL

Q: What is John Opilka's NPI number?

The NPI number for John Opilka is 1497715056. It was assigned to this individual provider in the NPPES registry on March 27, 2006.

Q: What is John Opilka's specialty?

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

Q: When was this NPI record last updated?

The NPPES record for John Opilka was last updated on April 6, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years 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.

Active since March 27, 2006PECOS EnrolledAccepts Medicare Assignment

91.8/100

CMS Quality Rating

5 E CUMBERLAND RD, ALTAMONT, IL 62411(618) 483-6151(618) 483-6153 Get Directions Write a Review

NPPES record last updated: April 6, 2023. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Apr 6, 2023, Mar 7, 2023, Mar 29, 2021 and 1 more (4 updates tracked since 2017).

On this page

About Dr. John P. Opilka D.o. NPPES

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

DR. JOHN P. OPILKA D.O. (NPI 1497715056) is an individual family medicine provider in Altamont, Illinois, licensed in Illinois (036099320) and active in the NPI registry since March 2006. He is enrolled in Medicare PECOS, is affiliated with St Anthonys Memorial Hospital, and is a graduate of Other (1996).

NPPES Registry Identity

NPI1497715056

Entity TypeIndividualMale

Primary Taxonomy207Q00000X

Provider Legal NameDR. JOHN P. OPILKACredential: D.O.

Location Address5 E CUMBERLAND RDAltamont, IL 62411-1271

Mailing Address1005 Health Center Dr Ste 201Mattoon, IL 61938-4653 · (217) 342-3400 · Fax (217) 258-2216

Phone(618) 483-6151

Fax(618) 483-6153

Sole ProprietorNo

Medical School CMSOtherGraduated 1996

Enumeration DateMarch 27, 2006

Last NPPES UpdateApril 6, 20234 updates tracked since enumeration

NPPES CertifiedApril 6, 2023

✔ NPI 1497715056 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 · 036099320

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.

5 E CUMBERLAND RD, Altamont, IL 62411

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Other Identifiers 7

Other080191496IL · Railroad Medicare

Other170988IL · Personal Care

Other1735285First Health/ Coventry

Other412343IL · Healthlink

Other0032540022IL · Blue Cross Blue Shield Il

Other055846IL · Health Alliance

Medicaid371391171001IL

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Dr. John P. Opilka D.o. 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 ID5698674984

PECOS Enrollment IDI20051121000215

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.

Areas of Expertise CMS Part B claims 27

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.

Subsequent nursing facility care with moderate level of medical decision making, per day, if using time, at least 30 minutes 99309

A follow-up nursing facility visit per day is a daily check-in by a healthcare professional. This 25-minute visit typically involves monitoring your health progress, addressing any concerns, and adjusting treatment plans as necessary. It's a vital part of ensuring your ongoing wellbeing.

874 services153 patients

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.

516 services247 patients

Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes 99232

Follow-up hospital inpatient care involves daily check-ups while you're admitted in the hospital. Typically, a healthcare provider spends about 25 minutes each day reviewing your condition, adjusting treatment if needed, and answering any questions you might have.

466 services140 patients

Hospital discharge day management, more than 30 minutes 99239

Hospital discharge day management over 30 minutes involves a detailed process to ensure a smooth transition from hospital to home. It includes final examinations, discussion of your hospital stay, post-discharge instructions, and coordinating follow-up care.

211 services139 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.

201 services148 patients

Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes 99223

Initial hospital inpatient care per day, typically 70 minutes, refers to the daily medical service provided to patients admitted to the hospital. This includes a comprehensive evaluation, diagnosis, treatment plan, and monitoring of your health condition. It ensures your well-being during your hospital stay.

142 services102 patients

Subsequent nursing facility care with high level of medical decision making, per day, if using time, at least 45 minutes 99310

A follow-up nursing facility visit is a routine check-up that typically lasts about 35 minutes. During this visit, your health status is evaluated, any changes in your condition are noted, and necessary adjustments to your care plan are made. It's an essential part of maintaining your health.

116 services73 patients

Injection, triamcinolone acetonide, not otherwise specified, 10 mg J3301

Triamcinolone acetonide is a medication used to reduce inflammation in the body. It's given as a 10 mg injection for conditions like allergies, arthritis, or skin problems. The injection helps to decrease swelling, redness, and itching.

84 services11 patients

Initial nursing facility care with high level of medical decision making, per day, if using time, 50 minutes or more 99306

An initial nursing facility visit is your first meeting with your healthcare team at a nursing facility. Lasting typically 45 minutes, this appointment involves a comprehensive health assessment and the creation of your personalized care plan. It's a crucial step to ensure your health and well-being.

78 services68 patients

Initial nursing facility care with moderate level of medical decision making, per day, if using time, at least 35 minutes 99305

An initial nursing facility visit per day is a service where a healthcare professional spends about 35 minutes assessing a patient's health status. This includes reviewing medical history, conducting a physical exam, and developing a care plan based on the patient's needs.

61 services53 patients

Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes 99233

Follow-up hospital inpatient care per day typically involves a 35-minute check-up by your healthcare provider. This service includes monitoring your health progress, adjusting your treatment plan if needed, and answering any questions you may have about your condition or care.

60 services53 patients

Transitional care management services for problem of high complexity 99496

Transitional care management services are designed to ensure a smooth transition from a hospital to home or another care setting for patients with complex health issues. These services include medication management, patient education, and coordination with healthcare providers.

54 services43 patients

Blood test, clotting time 85610

A clotting time blood test helps determine how quickly your blood forms clots, a process crucial to stop bleeding. During the test, a small blood sample is taken from your arm. The sample is then analyzed in a lab to see how long it takes for a clot to form.

53 services12 patients

Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes 99222

Initial hospital inpatient care is a service where a healthcare provider spends about 50 minutes per day overseeing your care while you're admitted in the hospital. This includes reviewing your health status, planning your treatment, and ensuring your safety and comfort.

51 services48 patients

Injection of drug or substance under skin or into muscle 96372

This procedure involves administering medication directly under the skin or into a muscle. A small needle is used to inject the drug, allowing it to be absorbed quickly into the bloodstream. It's a common method for delivering a variety of medications.

38 services25 patients

Administration of influenza virus vaccine G0008

The administration of the influenza virus vaccine, also known as the flu shot, is a simple procedure to protect against the flu. A healthcare provider injects a small dose of the vaccine into your arm. This stimulates your immune system to produce antibodies, which will help your body fight off the flu if exposed.

36 services36 patients

Influenza vaccine split virus, preservative free 90662

The Influenza Vaccine Split Virus, preservative-free, is a flu shot to protect against the influenza virus. It is made from parts of inactivated flu viruses and doesn't contain preservatives, reducing potential side effects. It helps your body develop immunity to the flu.

35 services35 patients

Nursing facility discharge management, more than 30 minutes 99316

Nursing facility discharge management over 30 minutes is a comprehensive process where a healthcare team prepares you for leaving the facility. It involves creating a tailored plan, coordinating care, and ensuring a smooth transition to your next care setting.

34 services31 patients

Routine electrocardiogram (ecg) using at least 12 leads with tracing 93005

An Electrocardiogram (ECG) is a simple, painless test that records the heart's electrical activity. Using 12 leads attached to your skin, it generates a tracing of your heart rhythm. It helps detect any heart problems by showing the timing and strength of electrical signals passing through each part of your heart.

32 services31 patients

Physician or allowed practitioner certification for medicare-covered home health services under a home health plan of care (patient not present), including contacts with home health agency and review of reports of patient status required by physicians and G0180

This is a service where a doctor or authorized practitioner certifies that you require Medicare-covered home health services. They will communicate with the home health agency and review reports on your health status to ensure you receive appropriate care. This does not involve an in-person visit.

23 services23 patients

Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more 99215

This service involves a follow-up appointment for existing patients, lasting between 40 to 54 minutes. During this time, your healthcare provider will assess your current health status, discuss any changes or concerns, review your treatment plan, and answer any questions you may have.

22 services19 patients

Subsequent nursing facility care with straightforward level of medical decision making, per day, if using time, 20 minutes or more 99308

A follow-up nursing facility visit per day is a daily check-up service provided by healthcare professionals. It lasts around 15 minutes and involves assessing your health status, monitoring your recovery progress, and addressing any concerns you may have about your health or treatment.

22 services16 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.

21 services21 patients

Aspiration and/or injection of fluid from large joint 20610

This procedure involves using a needle to remove (aspiration) or introduce (injection) fluid into a large joint like the knee or hip. It can help diagnose conditions, relieve discomfort, or deliver medication directly to the joint.

19 services11 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.

12 services11 patients

Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more 99212

This is a routine check-up for patients who have previously seen the doctor. During this 10-19 minute visit, the doctor will review your health status, discuss any concerns, and manage ongoing treatments or medications. It's a chance to ensure your health is on track.

11 services11 patients

Hospital discharge day management, 30 minutes or less 99238

Hospital discharge day management of 30 minutes or less includes finalizing your treatment, discussing your progress, and planning after-care at home. It ensures you're ready to leave the hospital and continue recovery safely.

11 services11 patients

Hospital Affiliations CMS Care Compare 3

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

St Anthonys Memorial Hospital

Acute Care Hospitals · Effingham, IL

3/5 CMS rating

OwnershipVoluntary non-profit - Church

CMS Certification Number140032

Location503 N Maple StreetEffingham, IL 62401 · Effingham 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

Fayette County Hospital

Critical Access Hospitals · Vandalia, IL

OwnershipVoluntary non-profit - Other

CMS Certification Number141346

Location650 W Taylor StVandalia, IL 62471 · Fayette County

Emergency services

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 62411 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

$85.71 typical visit price

range $54.80 – $168.44

Typical copayment $21.42 (range $13.70 – $42.11)

Most-billed visit code 99203

Established Patient

$97.25 typical visit price

range $17.16 – $136.56

Typical copayment $24.31 (range $4.29 – $34.14)

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.

91.8/100

MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program

Scored through an Alternative Payment Model

Quality

75.59

Promoting Interoperability

100

Improvement Activities

Referred Medical Equipment & Supplies CMS DME claims 34

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

12 suppliers116 claims226 services$6.01 avg. paid by Medicare

Lancets, per box of 100 A4259

DME-Medical/Surgical Supplies · category DA000N

6 suppliers19 claims22 services$1.10 avg. paid by Medicare

Insertion tray with drainage bag with indwelling catheter, foley type, two-way latex with coating (teflon, silicone, silicone elastomer or hydrophilic, etc.) A4314

DME-Orthotic Devices · category DF000N

1 supplier15 claims15 services$24.48 avg. paid by Medicare

Ostomy pouch, drainable; with barrier attached, (1 piece), each A5061

DME-Orthotic Devices · category DF010N

1 supplier11 claims50 services$3.41 avg. paid by Medicare

Administration set, with small volume nonfiltered pneumatic nebulizer, disposable A7003

DME-Other DME · category DE000N

2 suppliers17 claims33 services$1.71 avg. paid by Medicare

Full face mask used with positive airway pressure device, each A7030

DME-Other DME · category DE001N

6 suppliers54 claims54 services$110.65 avg. paid by Medicare

Face mask interface, replacement for full face mask, each A7031

DME-Other DME · category DE001N

6 suppliers51 claims125 services$40.51 avg. paid by Medicare

Pillow for use on nasal cannula type interface, replacement only, pair A7033

DME-Other DME · category DE001N

2 suppliers13 claims70 services$19.00 avg. paid by Medicare

Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap A7034

DME-Other DME · category DE001N

5 suppliers21 claims21 services$71.18 avg. paid by Medicare

Headgear used with positive airway pressure device A7035

DME-Other DME · category DE001N

6 suppliers45 claims45 services$23.81 avg. paid by Medicare

Tubing used with positive airway pressure device A7037

DME-Other DME · category DE001N

7 suppliers63 claims63 services$20.75 avg. paid by Medicare

Filter, disposable, used with positive airway pressure device A7038

DME-Other DME · category DE001N

6 suppliers76 claims361 services$2.67 avg. paid by Medicare

Water chamber for humidifier, used with positive airway pressure device, replacement, each A7046

DME-Other DME · category DE001N

4 suppliers35 claims35 services$13.14 avg. paid by Medicare

Walker, heavy duty, wheeled, rigid or folding, any type E0149

DME-Other DME · category DE000N

1 supplier11 claims11 services$8.27 avg. paid by Medicare

Powered pressure reducing mattress overlay/pad, alternating, with pump, includes heavy duty E0181

DME-Other DME · category DE000N

1 supplier15 claims15 services$16.44 avg. paid by Medicare

Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress E0260

DME-Hospital Beds · category DB000N

2 suppliers25 claims25 services$62.27 avg. paid by Medicare

Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing E0431

DME-Oxygen and Supplies · category DC000N

4 suppliers152 claims153 services$19.22 avg. paid by Medicare

Stationary oxygen contents, liquid, 1 month's supply = 1 unit E0442

DME-Oxygen and Supplies · category DC000N

1 supplier12 claims12 services$50.60 avg. paid by Medicare

Portable oxygen contents, liquid, 1 month's supply = 1 unit E0444

DME-Oxygen and Supplies · category DC000N

1 supplier12 claims12 services$48.51 avg. paid by Medicare

Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) E0466

DME-Other DME · category DE005N

2 suppliers21 claims21 services$906.70 avg. paid by Medicare

High frequency chest wall oscillation system, with full anterior and/or posterior thoracic region receiving simultaneous external oscillation, includes all accessories and supplies, each E0483

DME-Other DME · category DE000N

1 supplier14 claims14 services$839.87 avg. paid by Medicare

Humidifier, heated, used with positive airway pressure device E0562

DME-Other DME · category DE001N

2 suppliers36 claims36 services$16.86 avg. paid by Medicare

Nebulizer, with compressor E0570

DME-Other DME · category DE000N

4 suppliers47 claims48 services$8.24 avg. paid by Medicare

Continuous positive airway pressure (cpap) device E0601

DME-Other DME · category DE001N

2 suppliers47 claims47 services$48.80 avg. paid by Medicare

Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate E1390

DME-Oxygen and Supplies · category DC002N

5 suppliers284 claims284 services$113.53 avg. paid by Medicare

Portable oxygen concentrator, rental E1392

DME-Oxygen and Supplies · category DC002N

4 suppliers105 claims105 services$36.75 avg. paid by Medicare

Arformoterol, inhalation solution, fda approved final product, non-compounded, administered through dme, unit dose form, 15 micrograms J7605

DME-Drugs Administered Through DME · category DG006N

2 suppliers23 claims1,380 services$4.49 avg. paid by Medicare

Albuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose, 1 mg J7613

DME-Drugs Administered Through DME · category DG006N

5 suppliers22 claims5,530 services$0.04 avg. paid by Medicare

Albuterol, up to 2.5 mg and ipratropium bromide, up to 0.5 mg, fda-approved final product, non-compounded, administered through dme J7620

DME-Drugs Administered Through DME · category DG006N

3 suppliers19 claims2,100 services$0.09 avg. paid by Medicare

Budesonide, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, up to 0.5 mg J7626

DME-Drugs Administered Through DME · category DG000N

2 suppliers18 claims1,080 services$0.74 avg. paid by Medicare

Revefenacin inhalation solution, fda-approved final product, non-compounded, administered through dme, 1 microgram J7677

DME-Drugs Administered Through DME · category DG006N

1 supplier12 claims63,000 services$0.15 avg. paid by Medicare

Standard wheelchair K0001

DME-Wheelchairs · category DD000N

2 suppliers39 claims39 services$27.36 avg. paid by Medicare

Supply allowance for therapeutic continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service K0553

DME-Other DME · category DE017N

3 suppliers14 claims14 services$191.27 avg. paid by Medicare

Pharmacy dispensing fee for inhalation drug(s); per 30 days Q0513

DME-Other DME · category DE000N

5 suppliers68 claims68 services$25.71 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 7

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

MRS. ERIN M SWINGLER NP

Nurse Practitioner (Family)

5 E CUMBERLAND RD
ALTAMONT, IL 62411

Effingham County (618) 483-6151

RANDI LEIGH BERG

Nurse Practitioner (Family)

5 E CUMBERLAND RD
ALTAMONT, IL 62411

Effingham County (618) 483-6151

TAMMY L. SASSE APRN

Nurse Practitioner (Family)

5 E CUMBERLAND RD
ALTAMONT, IL 62411

Effingham County (618) 483-6131

KATHRYN LYNN KOESTER APRN

Nurse Practitioner (Family)

5 E CUMBERLAND RD
ALTAMONT, IL 62411

Effingham County (618) 483-6151

MID-ILLINOIS MEDICAL CARE ASSOCIATES, LLC

Clinic/Center (Rural Health)

5 E CUMBERLAND RD
ALTAMONT, IL 62411

Effingham County (618) 483-6151

HEATHER LYNN FORYS APN

Nurse Practitioner (Family)

5 E CUMBERLAND RD
ALTAMONT, IL 62411

Effingham County (618) 483-6151

KIMBERLEY S BURGESS APN

Nurse Practitioner (Family)

5 E CUMBERLAND RD
ALTAMONT, IL 62411

Effingham County (618) 483-6151

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 John Opilka's NPI number?

The NPI number for John Opilka is 1497715056. It was assigned to this individual provider in the NPPES registry on March 27, 2006.

Where is John Opilka located?

John Opilka practices at 5 E Cumberland Rd, Altamont, IL 62411. The listed phone number is (618) 483-6151.

What is John Opilka's specialty?

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

Is John Opilka enrolled in Medicare?

Yes. John Opilka 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.

Is John Opilka affiliated with any hospitals?

According to CMS data, John Opilka is affiliated with St Anthonys Memorial Hospital, Sarah Bush Lincoln Health Center and Fayette County Hospital.

When was this NPI record last updated?

The NPPES record for John Opilka was last updated on April 6, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years 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.