NPIMap

Individual provider Active NPI

Jaclyn Pranita Parayao, MD

  • Family Medicine Physician
  • Dixon, IL
National Provider Identifier
1184283590
Registry record updated Jun 10, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
125074429 Issued in IL
Practice address
102 S Hennepin Ave
Dixon, IL 61021-3013
Phone
(815) 285-8520
Fax
(815) 285-8903
NPI assigned
Jun 10, 2019
Last updated
Jun 10, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 10, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 125074429 IL Primary

Addresses

Primary practice location

102 S Hennepin Ave
Dixon, IL 61021-3013

Mailing address

102 S Hennepin Ave
Dixon, IL 61021-3013
Phone (815) 285-8520

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220901001772 IL Practitioner - Family Practice 9032516463 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Osf Multi-Specialty GroupGroup PAC ID 3678889789, 2,123 clinicians

Practice addresses (Care Compare)

102 S Hennepin Ave
Suite 201
Dixon, IL 61021-3013
Phone (815) 288-7711

1107 S Division Ave
Polo, IL 61064-1875
Phone (815) 946-3453

403 E 1St St
Dixon, IL 61021-3116
Phone (815) 288-5531

8600 State Route 91
Suite 130
Peoria, IL 61615-7829
Phone (309) 683-5050

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
82.78 of 100Reported as group
Quality
60.49
Promoting interoperability
100
Improvement activities
40
Cost
77.11

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal or shaving of skin growth1-10
Skin biopsy1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
125074429ILMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
KSB Medical Group, Inc. Family Medicine CurrentSince Aug 1, 2022 Accepting new patients
KSB Medical Group, Inc. CurrentSince Aug 1, 2022 Accepting new patients
Central PA Pharmacy LLC. Current Accepting new patients
Osf Multi-Specialty Group CurrentSince Nov 26, 2024 Accepting new patients
Franklin Grove Living & Rehabilitation Center, LLC PastSince Jul 25, 2022 Accepting new patients

Locations

102 S Hennepin Ave
Dixon, IL 61021
Phone (815) 285-8520

215 E 1st St
Ste 111
Dixon, IL 61021
Phone (815) 285-5477

215 E 1st St
Ste 117
Dixon, IL 61021
Phone (815) 285-5900

403 E 1st St
Dixon, IL 61021
Phone (815) 285-5629

1420 W Pioneer Pkwy
Peoria, IL 61615
Phone (309) 308-5195

8600 State Route 91
Ste 130
Peoria, IL 61615
Phone (309) 683-5050

1107 S Division Ave
Polo, IL 61064
Phone (815) 946-3453

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
DiningrdFranklin Grove, IL, CCN 145200 Skilled nursing facility Corporate Officer
Operational/Managerial Control
Adp of the SNF		 Jul 25, 2022
Jul 25, 2022
Jan 28, 2026

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 5

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.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1560124800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1560124800000",
    "number": "1184283590",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "102 S HENNEPIN AVE",
            "city": "DIXON",
            "state": "IL",
            "postal_code": "610213013",
            "telephone_number": "815-285-8520",
            "fax_number": "815-285-8903"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "102 S HENNEPIN AVE",
            "city": "DIXON",
            "state": "IL",
            "postal_code": "610213013",
            "telephone_number": "815-285-8520",
            "fax_number": "815-285-8903"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARAYAO",
        "first_name": "JACLYN",
        "middle_name": "PRANITA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-06-10",
        "last_updated": "2019-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "125074429",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dixon, IL

Sources for this page

Verify at the official NPI Registry.