Jenna Dornak

Primary specialty

Physician AssistantTaxonomy code 363A00000X

Practice address

4500 Memorial Dr
Belleville, IL 62226-5360

Phone

(618) 233-7750

NPI assigned

Jan 30, 2019

Last updated

Dec 29, 2021By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in AZ

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jdornak1019020@direct.carenet.org

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.

• Honorhealth

  dba HonorHealth Contract Providers

  • Surgery Physician
  • Scottsdale, AZ
  • NPI 1801092564
  Medicare reassignment NPD
• Scottsdale Emergency Associates, LTD.

  • Emergency Medicine Physician
  • Scottsdale, AZ
  • NPI 1083671432
  Medicare reassignment
• Scottsdale Emergency Associates, LTD.

  • Emergency Medicine Physician
  • Scottsdale, AZ
  • NPI 1023298551

  Physician Assistant

  NPD
• Scottsdale Emergency Associates, LTD.

  • Emergency Medicine Physician
  • Scottsdale, AZ
  • NPI 1174570923

  Physician Assistant

  NPD

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

{
    "created_epoch": "1548806400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1640736000000",
    "number": "1124582523",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5800 HIGHLANDS PLAZA DR APT 133",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631101358"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4500 MEMORIAL DR",
            "city": "BELLEVILLE",
            "state": "IL",
            "postal_code": "622265360",
            "telephone_number": "618-233-7750"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DORNAK",
        "first_name": "JENNA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-01-30",
        "last_updated": "2021-12-29",
        "certification_date": "2021-12-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
            "affiliation": "Y",
            "affiliationName": "PROTESTANT MEMORIAL MEDICAL CENTER, INC.",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "4500 Memorial Dr",
            "city": "Belleville",
            "state": "IL",
            "country_code": "US",
            "postal_code": "622265360",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Abigail Dold, MOTR/L
• Janice Marie Donaldson, LCSW
• Matthew Michael Donaldson, MD
• James Dooley, DPT
• Courtney Doran I, PA
• Joelle Dorries, PA-C
• Scott M Dorrity, DC
• Douglas Dothager, MD
• Angelia Dotson
• Double the Help Home Health Care

• Physician Assistant in Belleville, IL
• Providers in Belleville, IL by specialty
• Physician Assistant in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 29, 2021; 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.