Jarod Dwayne Skouby, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

036132100 Issued in IL

Practice address

3165 Myrtle Ave
Suite 2
Granite City, IL 62040-5012

Phone

(618) 876-7500

NPI assigned

May 3, 2010

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jskouby13269@direct-ehr-ssmhc.com

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

• SSM Cardinal Glennon Childrens Hospital

  • Pediatrics Physician
  • Saint Louis, MO
  • NPI 1073568226

  IL

  Medicare reassignment NPD
• SSM Cardinal Glennon Childrens Hospital

  • Pediatrics Physician
  • O Fallon, IL
  • NPI 1174577670
  NPD
• SSM Cardinal Glennon Children'S Hospital

  • Pediatrics Physician
  • Warrenton, MO
  • NPI 1962573212
  NPD

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

{
    "created_epoch": "1272844800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1376092800000",
    "number": "1124345939",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3165 MYRTLE AVE",
            "address_2": "SUITE 2",
            "city": "GRANITE CITY",
            "state": "IL",
            "postal_code": "620405012",
            "telephone_number": "618-876-7500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3165 MYRTLE AVE",
            "address_2": "SUITE 2",
            "city": "GRANITE CITY",
            "state": "IL",
            "postal_code": "620405012",
            "telephone_number": "618-876-7500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SKOUBY",
        "first_name": "JAROD",
        "middle_name": "DWAYNE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-05-03",
        "last_updated": "2013-08-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IL",
            "license": "036132100",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amanda Michelle Simon, HHP, LMT
• Kristen Sinclair, NP
• Mia Sing
• Emily Sisk, MS, RD, LDN, IBCLC
• Donna Catherine Skouby, CNP
• Diana Smith
• George Alvin Smith, MA, LCPC, CSADC
• Mavis Lynne Smith, RPH
• Zachary Smith
• Timothy E Snyder, CRADC

• Pediatrics Physician in Granite City, IL
• Providers in Granite City, IL by specialty
• Pediatrics Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.