Individual provider Active NPI

Jerry A Iavarone, D.C.

  • Chiropractor
  • Addison, IL
National Provider Identifier
1053308973
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
Practice address
1250 W Lake St
Suite 17
Addison, IL 60101-5744
Phone
(630) 543-7246
Fax
(630) 543-7287
NPI assigned
Oct 5, 2005
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X IL Primary

Addresses

Primary practice location

1250 W Lake St
Suite 17
Addison, IL 60101-5744

Mailing address

1250 W Lake St
Suite 17
Addison, IL 60101-5744
Phone (630) 543-7246

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20081023000248 IL Practitioner - Chiropractic 3577517796 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
National College of Chiropractic, 1985
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Illinois Neuro and Physical Rehabilitation LTDGroup PAC ID 6204092539, 4 clinicians

Practice addresses (Care Compare)

199 S Addison Rd
Wood Dale, IL 60191-1978

199 S Addison Rd
105 106
Wood Dale, IL 60191-1929
Phone 63076615522

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
038-005656ILMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Illinois Neuro & Physical Rehabilitation LTD Chiropractor CurrentSince Aug 3, 2013 Accepting new patients
Neurologic Wellness Institute PLLC Past Accepting new patients
Addison Physical Medicine and Rehabilitation Center LTD. Chiropractor Past Accepting new patients

Locations

199 S Addison Rd
Wood Dale, IL 60191
Phone (630) 766-1552

199 S Addison Rd
#105106
Wood Dale, IL 60191
Phone (630) 766-1552

199 S Addison Rd
Ste 105106
Wood Dale, IL 60191
Phone (630) 766-1552

199 S Addison Rd
Ste 106
Wood Dale, IL 60191
Phone (630) 766-1552

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1128470400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1053308973",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1250 W LAKE ST",
            "address_2": "SUITE 17",
            "city": "ADDISON",
            "state": "IL",
            "postal_code": "601015744",
            "telephone_number": "630-543-7246",
            "fax_number": "630-543-7287"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1250 W LAKE ST",
            "address_2": "SUITE 17",
            "city": "ADDISON",
            "state": "IL",
            "postal_code": "601015744",
            "telephone_number": "630-543-7246",
            "fax_number": "630-543-7287"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IAVARONE",
        "first_name": "JERRY",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-05",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Addison, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.