Provider Demographics
NPI:1427016062
Name:HOPPER, JAMES J (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:J
Last Name:HOPPER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5520 GODFREY RD STE B
Mailing Address - Street 2:
Mailing Address - City:GODFREY
Mailing Address - State:IL
Mailing Address - Zip Code:62035-2741
Mailing Address - Country:US
Mailing Address - Phone:618-463-7800
Mailing Address - Fax:
Practice Address - Street 1:5520 GODFREY RD STE B
Practice Address - Street 2:
Practice Address - City:GODFREY
Practice Address - State:IL
Practice Address - Zip Code:62035-2741
Practice Address - Country:US
Practice Address - Phone:618-463-7800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085-000496207P00000X
IL085000496363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL601151600OtherUS DEPT OF LABOR
IL08220357OtherBCBS
IL900068033OtherTAX-ID#
ILP00299510OtherRR MEDICARE#
R16590Medicare UPIN
IL900068033OtherTAX-ID#
IL567730001Medicare PIN