Active NPI
Jacob Ivey, PHARM D
- Pharmacist
- Marion, IL
National Provider Identifier
1235779125
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 2013011981
- Practice address
- 3333 W Deyoung St
Marion, IL 62959-5884 - Phone
- (618) 998-7821
- NPI assigned
- Jan 8, 2020
- Last updated
- Nov 27, 2023
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Pharmacist | 183500000X | 2013011981 | MO | Primary |
Addresses
Primary practice location
3333 W Deyoung St
Marion, IL 62959-5884
Mailing address
11795 Songbird Rd
Marion, IL 62959-6877
Phone (618) 694-1075
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2013011981 | Other | MO | PHARMACIST |
| PS60361 | Other | FL | PHARMACIST |
| 051.291535 | Other | IL | PHARMACIST |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Other URL | www.quorumhealth.com | Heartland Regional Medical Center |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2013011981 | MO | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1578441600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1701043200000",
"number": "1235779125",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11795 SONGBIRD RD",
"city": "MARION",
"state": "IL",
"postal_code": "629596877",
"telephone_number": "618-694-1075"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3333 W DEYOUNG ST",
"city": "MARION",
"state": "IL",
"postal_code": "629595884",
"telephone_number": "618-998-7821"
}
],
"practiceLocations": [],
"basic": {
"last_name": "IVEY",
"first_name": "JACOB",
"name_prefix": "Dr.",
"credential": "PHARM D",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-01-08",
"last_updated": "2023-11-27",
"certification_date": "2020-01-08",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MO",
"license": "2013011981",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PHARMACIST",
"identifier": "2013011981",
"state": "MO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PHARMACIST",
"identifier": "PS60361",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PHARMACIST",
"identifier": "051.291535",
"state": "IL"
}
],
"endpoints": [
{
"endpointType": "OTHERS",
"endpointTypeDescription": "Other URL",
"endpoint": "www.quorumhealth.com",
"affiliation": "Y",
"affiliationName": "Heartland Regional Medical Center",
"address_1": "3333 W DeYoung St",
"city": "Marion",
"state": "IL",
"country_code": "US",
"postal_code": "629595884",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Marion, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.