Active NPI
Jason R Talley, DC
- Chiropractor
- Granite City, IL
National Provider Identifier
1144224734
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 038-009072
- Practice address
- 2025 Edison Ave
Granite City, IL 62040-4514 - Phone
- (618) 451-2874
- Fax
- (618) 451-2858
- NPI assigned
- Jun 10, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 038-009072 | IL | Primary |
Addresses
Primary practice location
2025 Edison Ave
Granite City, IL 62040-4514
Mailing address
3100 Maryville Rd
Granite City, IL 62040-5185
Phone (618) 451-2874
Other identifiers 6
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4400069 | Other | IL | UNITED HEALTH CARE |
| 442971 | Other | IL | HEALTHLINK |
| 350054835 | Other | IL | RAILROAD MEDICARE |
| 6026195 | Other | IL | BLUE CROSS BLUE SHIELD |
| U81510 | Other | IL | MERCY |
| 038009072 | Medicaid | IL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20060921000045 | IL | Practitioner - Chiropractic | 6204831563 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 038-009072 | IL | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1118361600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1575417600000",
"number": "1144224734",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3100 MARYVILLE RD",
"city": "GRANITE CITY",
"state": "IL",
"postal_code": "620405185",
"telephone_number": "618-451-2874",
"fax_number": "618-451-2858"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2025 EDISON AVE",
"city": "GRANITE CITY",
"state": "IL",
"postal_code": "620404514",
"telephone_number": "618-451-2874",
"fax_number": "618-451-2858"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TALLEY",
"first_name": "JASON",
"middle_name": "R",
"name_prefix": "Dr.",
"credential": "DC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-06-10",
"last_updated": "2019-12-04",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "IL",
"license": "038-009072",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED HEALTH CARE",
"identifier": "4400069",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTHLINK",
"identifier": "442971",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "350054835",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "6026195",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MERCY",
"identifier": "U81510",
"state": "IL"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "038009072",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Granite City, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.