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

Jon O Humphrey, MD

Individual provider Sports Medicine (Family Medicine) Physician · NPI 1699972893

Jon O Humphrey, MD is a Family Practice in Carbondale, Illinois. Graduated from Southern Illinois University School of Medicine in 1997, 29 years ago. Practices with Amg-Livingston LLC, an 18-clinician group and accepts Medicare assignment. Licensed in Illinois and Tennessee.

Years since qualifying
29
Trained at
Southern Illinois University School of Medicine
Licensed in
IL, TN
In the registry since
2007
Specialties on file
2
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

305 W Jackson St Ste 200
Carbondale, IL 62901-1474
Phone: (618) 453-3777
Fax: (618) 453-1102
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X · Licence 67471 (TN)
Sports Medicine (Family Medicine) Physician Taxonomy 207QS0010X · Licence 036-116062 (IL)

Record details

NPI number1699972893
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorNo
NPI enumeratedJune 29, 2007
Last updated in NPPESJune 10, 2024
Certification dateJune 10, 2024
Mailing address701 N 1st St, Po Box 19639, Springfield, IL 62794-9639

Medicare enrollment

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

Medicare specialtyFAMILY PRACTICE
Medical schoolSOUTHERN ILLINOIS UNIVERSITY SCHOOL OF MEDICINE
Graduated 1997 (29 years in practice)
Group practice Amg-Livingston Llc — 18 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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