Individual provider Active NPI

Jaylene M Jennings, PA-C

  • Physician Assistant
  • Sycamore, IL
National Provider Identifier
1265016984
Registry record updated Jan 17, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
085009139 Issued in IL
Practice address
1830 Mediterranean Dr
Sycamore, IL 60178-3144
Phone
(815) 766-3873
Fax
(815) 766-7713
NPI assigned
May 9, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 17, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 085009139 IL Primary

Addresses

Primary practice location

1830 Mediterranean Dr
Sycamore, IL 60178-3144

Mailing address

1830 Mediterranean Dr
Sycamore, IL 60178-3144
Phone (815) 766-3873

Medicare participation

Medicare enrollment files
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: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20221017001845 IL Practitioner - Physician Assistant 4183090103 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

1 Kish Hospital Dr
Dekalb, IL 60115-9602
Phone (815) 766-7334

1830 Mediterranean Dr
Sycamore, IL 60178-3144
Phone (815) 766-3873

5 Kish Hospital Dr
Dekalb, IL 60115-9602

515 Valley View Dr
Suite 201
Moline, IL 61265-6175
Phone (312) 695-0870

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
95.19 of 100Reported as apm
Quality
83.05
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
085009139ILMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Northwestern Medical Faculty Foundation CurrentSince Jun 13, 2023 Accepting new patients
Central Dupage Physician Group CurrentSince Sep 1, 2022 Accepting new patients
Northwestern Medical Faculty Foundation CurrentSince Jun 13, 2023 Accepting new patients

Locations

Dept 5777
Carol Stream, IL 60122

Carol Stream, IL 60122
Phone (630) 933-3300

660 N Westmoreland Rd
#302
Lake Forest, IL 60045

515 Valley View Dr
Ste 201
Moline, IL 61265
Phone (312) 695-0870

1830 Mediterranean Dr
Sycamore, IL 60178
Phone (815) 306-2700

1800 N Main St
Wheaton, IL 60187
Phone (630) 469-0045

Organizations & group practices 4

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.

Hospital & facility affiliations 4

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": "1620518400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1673913600000",
    "number": "1265016984",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1830 MEDITERRANEAN DR",
            "city": "SYCAMORE",
            "state": "IL",
            "postal_code": "601783144",
            "telephone_number": "815-766-3873",
            "fax_number": "815-766-7713"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1830 MEDITERRANEAN DR",
            "city": "SYCAMORE",
            "state": "IL",
            "postal_code": "601783144",
            "telephone_number": "815-766-3873",
            "fax_number": "815-766-7713"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JENNINGS",
        "first_name": "JAYLENE",
        "middle_name": "M",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-05-09",
        "last_updated": "2023-01-17",
        "certification_date": "2023-01-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085009139",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sycamore, IL

Sources for this page

Verify at the official NPI Registry.