Provider Demographics
NPI:1831207349
Name:CHAMBERLIN, JASON G (DO)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:G
Last Name:CHAMBERLIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:IL
Mailing Address - Zip Code:61520-2608
Mailing Address - Country:US
Mailing Address - Phone:309-647-0201
Mailing Address - Fax:309-647-8613
Practice Address - Street 1:601 E FORT ST
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61531-0380
Practice Address - Country:US
Practice Address - Phone:309-245-2406
Practice Address - Fax:309-649-6880
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036101084208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036101084Medicaid
IL1942315197OtherNPI CLINIC NUMBER
ILCG5172OtherRR MEDICARE GROUP#
IL461760OtherHEALTH LINK
ILIL0139OtherJOHN DEERE
IL02922981OtherBCBS
IL200397OtherBLACK LUNG
IL101084OtherOSF HEALTHPLANS
IL069684OtherHEALTH ALLIANCE
IL0062839OtherUMWA
IL200397OtherBLACK LUNG
IL069684OtherHEALTH ALLIANCE
ILCG5172OtherRR MEDICARE GROUP#
IL036101084Medicaid