Jenna Dornak
Individual provider Active NPI Physician Assistant · Belleville, IL
NPI 1124582523 · NPPES record last updated Dec 29, 2021
Key facts
- NPI
- 1124582523
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- Practice address
- 4500 Memorial Dr
Belleville, IL 62226-5360 - Phone
- (618) 233-7750
- NPI assigned
- Jan 30, 2019
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 5
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AZ
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230606001275 | AZ | Practitioner - Physician Assistant | 5294069118 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Honorhealth | Current |
Accepting new patients | |
| Scottsdale Emergency Associates, LTD. | Physician Assistant | Current |
Accepting new patients |
| Scottsdale Emergency Associates, LTD. | Physician Assistant | Current |
Accepting new patients |
| Honorhealth | Current |
Accepting new patients |
Locations
2500 W Utopia Rd
Ste 100
Phoenix, AZ 85027
Phone (623) 683-4462
5316 E Shea Blvd
Ste 150
Scottsdale, AZ 85254
Phone (480) 534-4530
7400 E Osborn Rd
Scottsdale, AZ 85251
Phone (480) 481-4000
Interoperability endpoints
- jdornak1019020@direct.carenet.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | Yes |
Addresses
Primary practice location
4500 Memorial Dr
Belleville, IL 62226-5360
Mailing address
5800 Highlands Plaza Dr Apt 133
Saint Louis, MO 63110-1358
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| FHIR URL | https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/ | Health Information Exchange (HIE) | PROTESTANT MEMORIAL MEDICAL CENTER, INC. |
Other providers in Belleville, IL
- Abigail Dold
- Janice Marie Donaldson
- Matthew Michael Donaldson
- James Dooley
- Courtney Doran I
- Joelle Dorries
- Scott M Dorrity
- Douglas Dothager
- Angelia Dotson
- Double the Help Home Health Care
All providers in Belleville, IL · Physician Assistant in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 29, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.