Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

James R Mangerson, PA-C

Individual provider Physician Assistant · NPI 1093078446

James R Mangerson, PA-C is a Physician Assistant in Peoria, Illinois. Qualified in 2012, 14 years ago. Practices with Prohealth Medical Group Inc, a 472-clinician group, works from 3 locations and accepts Medicare assignment. Licensed in Illinois, Ohio and Wisconsin.

Years since qualifying
14
Licensed in
IL, OH, WI
In the registry since
2012
Specialties on file
3
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

515 NE Glen Oak Ave Ste 202
Peoria, IL 61603-3166
Phone: (309) 624-4455
Fax: (309) 624-3457
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (2)

  • 3533 Southern Blvd Ste 5650, Kettering, OH 45429-1263 — (937) 294-3611
  • 721 American Ave, Waukesha, WI 53188-5071 — (262) 928-5300

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 085010994 (IL)
Physician Assistant Taxonomy 363A00000X · Licence 2956 (WI)
Physician Assistant Taxonomy 363A00000X · Licence 50.008880RX (OH)

Record details

NPI number1093078446
Entity typeIndividual (Type 1)
GenderMale
Credentials PA-C
Sole proprietorNo
NPI enumeratedJune 20, 2012
Last updated in NPPESJanuary 27, 2025
Certification dateJanuary 27, 2025

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2012 (14 years in practice)
Group practice Prohealth Medical Group Inc — 472 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations7 on file with Medicare

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