Basic Information
| Provider Information | |||||||||
| NPI: | 1063593382 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CASH | ||||||||
| FirstName: | JASON | ||||||||
| MiddleName: | W | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 6002 | ||||||||
| Address2: | |||||||||
| City: | URBANA | ||||||||
| State: | IL | ||||||||
| PostalCode: | 618036002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2173833311 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1701 EAST COLLEGE AVENUE | ||||||||
| Address2: | |||||||||
| City: | BLOOMINGTON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 61701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3096643333 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/17/2006 | ||||||||
| LastUpdateDate: | 04/07/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/07/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD00044596 | WA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 36118153 | IL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 833120 | 01 | IL | MEDICARE GROUP # | OTHER | 036118153 | 05 | IL | MEDICAID | 0533210001 | 01 | IL | DMERC | OTHER | IL2613 | 01 | MEDICARE GROUP # | OTHER |