JERRY PRIDDY (PA-C) – Physician Assistant, NPI 1003351115
Physician Assistant
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
5,035 PHYSICIAN ASSISTANT in IL
Provider Addresses for JERRY PRIDDY (PA-C)
1301, South Koke Mill Road, Springfield, Sangamon County, Illinois, 62711, United States
SPRINGFIELD, IL 627119252
Phone: (217) 547-9100
Fax: (217) 547-9236
Type: Mailing
619 E MASON ST STE 5
SPRINGFIELD, IL 627011080
Phone: (217) 545-8000
Fax: (217) 545-2552
Type: Location
PO BOX 19639
SPRINGFIELD, IL 627949639
Phone: (217) 545-8000
Type: Mailing
1301 S Koke Mill Rd
Springfield, IL 62711
Phone: (217) 547-9100
Fax: (217) 547-9236
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2017-04-18
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20170418001025 | I | Physician Assistant | IL | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 99232 | Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes | 52 | 30 | $0 |
| 99231 | Subsequent hospital care with straightforward or low level of medical decision making, per day, if using time, at least 25 minutes | 29 | 19 | $0 |
| 99222 | Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes | 18 | 18 | $0 |
| 99239 | Hospital discharge day management, more than 30 minutes | 18 | 18 | $0 |
Insurance plans in this area (ZIP 62711)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Internal Medicine | IL | |
| Pulmonary Disease | IL | |
| D E R M A T O L O G Y | IL | |
| - | IL | |
| E N D O C R I N O L O G Y | IL | |
| Physician Assistant | IL | |
| General Surgery | IL | |
| Nurse Practitioner | IL | |
| Nurse Practitioner | IL | |
| D E R M A T O L O G Y | IL |
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