Jacob Lee Wertz, D.D.S.

Primary specialty

DentistTaxonomy code 122300000X

License

019.029888 Issued in IL

Practice address

1300 W 2ND St
Rock Falls, IL 61071-1005

Phone

(815) 626-2230

Fax

(815) 626-6339

NPI assigned

Jul 7, 2014

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

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: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: jacob.wertz.p16@direct.fhn-fqhc.nextgenshare.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.

• County of Whiteside

  • Federally Qualified Health Center (FQHC)
  • Rock Falls, IL
  • NPI 1528008034
  NPD (past)
• County of Whiteside

  • Public Health or Welfare Agency
  • Rock Falls, IL
  • NPI 1699778373

  Dentist

  NPD (past)

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

{
    "created_epoch": "1404691200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1404691200000",
    "number": "1164838579",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1300 W 2ND ST",
            "city": "ROCK FALLS",
            "state": "IL",
            "postal_code": "610711005",
            "telephone_number": "815-626-2230",
            "fax_number": "815-626-6339"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 W 2ND ST",
            "city": "ROCK FALLS",
            "state": "IL",
            "postal_code": "610711005",
            "telephone_number": "815-626-2230",
            "fax_number": "815-626-6339"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WERTZ",
        "first_name": "JACOB",
        "middle_name": "LEE",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-07-07",
        "last_updated": "2014-07-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IL",
            "license": "019.029888",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WI",
            "license": "7278-15",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Darrin Vits, OD
• Walgreen Co
• Walgreen Co.
• Walmart Inc.
• Robert Harold Walsh Jr.
• Bailey Bernice Wetzell, DC
• Whiteside County Community Health Clinic
• Whiteside County Community Health Clinic
• Whiteside County School Dist 301
• Susan Wilhelm, LCSW

• Dentist in Rock Falls, IL
• Providers in Rock Falls, IL by specialty
• Dentist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2014; 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.