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DR. JAMES FERNANDEZ M.D.
NPI 1528037280
Otolaryngology in Granite City, IL

Active since March 15, 2006PECOS EnrolledAccepts Medicare Assignment
2120 MADISON AVE, SUITE 200, GRANITE CITY, IL 62040(618) 451-1800(618) 451-1526 Get Directions Write a Review

NPPES record last updated: January 23, 2008. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Dr. James Fernandez M.d. NPPES

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

DR. JAMES FERNANDEZ M.D. (NPI 1528037280) is an individual otolaryngology provider in Granite City, Illinois, licensed in Missouri (R6F41) and active in the NPI registry since March 2006. He is enrolled in Medicare PECOS and is a graduate of Saint Louis University School Of Medicine (1981).

NPPES Registry Identity

NPI1528037280
Entity TypeIndividualMale
Primary Taxonomy207Y00000X
Provider Legal NameDR. JAMES FERNANDEZCredential: M.D.
Location Address2120 MADISON AVE, SUITE 200Granite City, IL 62040-4744
Mailing Address59 Lake FrstSaint Louis, MO 63117-1303
Phone(618) 451-1800
Fax(618) 451-1526
Sole ProprietorNo
Medical School CMSSaint Louis University School Of MedicineGraduated 1981
Enumeration DateMarch 15, 2006
Last NPPES UpdateJanuary 23, 2008
✔ NPI 1528037280 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyOtolaryngologyAllopathic & Osteopathic Physicians
Taxonomy Code207Y00000X
License✔ Licensed in MO · R6F41
Definition
An otolaryngologist-head and neck surgeon provides comprehensive medical and surgical care for patients with diseases and disorders that affect the ears, nose, throat, the respiratory and upper alimentary systems and related structures of the head and neck. An otolaryngologist diagnoses and provides medical and/or surgical therapy or prevention of diseases, allergies, neoplasms, deformities, disorders and/or injuries of the ears, nose, sinuses, throat, respiratory and upper alimentary systems, face, jaws and the other head and neck systems. Head and neck oncology, facial plastic and reconstructive surgery and the treatment of disorders of hearing and voice are fundamental areas of expertise.
2120 MADISON AVE, Granite City, IL 62040
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Other Identifiers 2

Medicare UPIND16137
Medicare ID-Type Unspecified755660

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Home State Health, Ambetter Health, Ambetter Health of Delaware and more.Insurance ›

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. James Fernandez M.d. 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 ID446256838
PECOS Enrollment IDI20120530000356
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 3

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.

New patient office or other outpatient visit with straightforward medical decision making, if using time, 15 minutes or more 99202
This service involves an initial visit to the doctor's office or other outpatient setting. It typically lasts between 15-29 minutes. The doctor will review your medical history, conduct a physical examination, and discuss your health concerns. It's a chance to establish your health baseline and address any immediate medical issues.
22 services22 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.
21 services20 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.
16 services12 patients

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 62040 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
$131.14 typical visit price
range $56.28 – $173.35
Typical copayment $32.78 (range $14.07 – $43.33)
Most-billed visit code 99204
Established Patient
$70.42 typical visit price
range $17.51 – $139.99
Typical copayment $17.60 (range $4.37 – $34.99)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 6

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

GRANITE CITY PSYCHIATRY LLC
Clinic/Center (Mental Health (Including Community Mental Health Center))
2120 MADISON AVE, SUITE 405
GRANITE CITY, IL 62040
Madison County (618) 876-0653
ILLINOIS EAR, NOSE AND THROAT ASSOCIATES, P.C
Otolaryngology
2120 MADISON AVE, SUITE 200
GRANITE CITY, IL 62040
Madison County (618) 451-1800
DR. ARIF HABIB MD
Psychiatry & Neurology (Psychiatry)
2120 MADISON AVE, STE 404
GRANITE CITY, IL 62040
Madison County (618) 876-7515
MR. KARL RAYMOND GUNDERSEN MD
Psychiatry & Neurology (Psychiatry)
2120 MADISON AVE, STE 405
GRANITE CITY, IL 62040
Madison County (618) 876-0653
DR. JEFFREY FIERSTEIN M.D.
Otolaryngology
2120 MADISON AVE, SUITE 200
GRANITE CITY, IL 62040
Madison County (618) 451-1800
MID-AMERICA PSYCHIATRIC CONSULTANTS, LLC
Psychiatry & Neurology (Psychiatry)
2120 MADISON AVE, SUITE 404
GRANITE CITY, IL 62040
Madison County (618) 876-7515

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 James Fernandez's NPI number?

The NPI number for James Fernandez is 1528037280. It was assigned to this individual provider in the NPPES registry on March 15, 2006.

Where is James Fernandez located?

James Fernandez practices at 2120 Madison Ave Suite 200, Granite City, IL 62040. The listed phone number is (618) 451-1800.

What is James Fernandez's specialty?

The primary specialty registered for this NPI is Otolaryngology with taxonomy code 207Y00000X.

Is James Fernandez enrolled in Medicare?

Yes. James Fernandez 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.

What insurance does James Fernandez accept?

Health plans from Ambetter Health, Ambetter Health of Delaware, Ambetter from Home State Health and UnitedHealthcare list James Fernandez 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.

When was this NPI record last updated?

The NPPES record for James Fernandez was last updated on January 23, 2008. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 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.