NPIMap

Individual provider Active NPI

Jessica Jean Prange, M.D.

  • Cardiovascular Disease Physician
  • Effingham, IL
National Provider Identifier
1306089024
Registry record updated Dec 21, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
0036.137347 Issued in IL
Practice address
503 N Maple St
Effingham, IL 62401-2006
Phone
(217) 342-2121
Fax
(217) 347-1563
NPI assigned
Apr 10, 2009
Last updated
Dec 21, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 21, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Cardiovascular Disease Physician 207RC0000X 0036.137347 IL Primary

Addresses

Primary practice location

503 N Maple St
Effingham, IL 62401-2006

Mailing address

503 N Maple St
Effingham, IL 62401-2006
Phone (217) 342-2121

Other identifiers 2

IdentifierTypeStateIssuer
P01514409OtherILRAILROAD
036137347MedicaidIL

Other names 1

  • Ms. Jessica Jean Jatcko Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jprange100101@ewd.direct.hshs.org Direct

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
I20150625000022 IL Practitioner - Cardiovascular Disease (Cardiology)Practitioner - Internal Medicine 6507177094 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)Also: Internal Medicine
Education
Southern Illinois University School of Medicine, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Salem Township HospitalGroup PAC ID 0840195277, 26 clinicians

Practice addresses (Care Compare)

1201 Ricker Rd
Salem, IL 62881-4263
Phone 61854831948188

503 N Maple St
Effingham, IL 62401-2006
Phone (217) 342-2121

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
0036.137347ILMDCardiovascular Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Salem Township Hospital CurrentSince Jan 1, 2019 Accepting new patients
St Anthonys Memorial Hospital of the Hospital Sisters of the Third CurrentSince Aug 1, 2015 Accepting new patients
Salem Township Hospital CurrentSince Jan 1, 2019 Accepting new patients
Prairie Cardiovascular Consultants LTD Cardiovascular Disease CurrentSince Aug 3, 2015 Accepting new patients
HSHS Medical Group Inc Past Accepting new patients
Prairie Cardiovascular Consultants LTD Cardiovascular Disease Past Accepting new patients
Salem Township Hospital Past Accepting new patients

Locations

409 W Oak St
Carbondale, IL 62901
Phone (618) 429-4455

1770 E Lake Shore Dr
Ste 105
Decatur, IL 62521
Phone (217) 329-1000

503 N Maple St
Effingham, IL 62401
Phone (217) 342-2121

3 Saint Elizabeth Blvd
Ste 2800
O Fallon, IL 62269
Phone (618) 233-6044

1201 Ricker Rd
Salem, IL 62881
Phone (618) 548-3194

619 E Mason St
#4P57
Springfield, IL 62701

619 E Mason St
Ste 4
Springfield, IL 62701

Interoperability endpoints

  • Direct secure messaging: jprange100101@ewd.direct.hshs.org

Organizations & group practices 7

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 6

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": "1239321600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1640044800000",
    "number": "1306089024",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "503 N MAPLE ST",
            "city": "EFFINGHAM",
            "state": "IL",
            "postal_code": "624012006",
            "telephone_number": "217-342-2121",
            "fax_number": "217-347-1563"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "503 N MAPLE ST",
            "city": "EFFINGHAM",
            "state": "IL",
            "postal_code": "624012006",
            "telephone_number": "217-342-2121",
            "fax_number": "217-347-1563"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRANGE",
        "first_name": "JESSICA",
        "middle_name": "JEAN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-04-10",
        "last_updated": "2021-12-21",
        "certification_date": "2021-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "IL",
            "license": "0036.137347",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD",
            "identifier": "P01514409",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036137347",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jprange100101@ewd.direct.hshs.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/CCD/TXT",
            "address_1": "503 N Maple St",
            "city": "Effingham",
            "state": "IL",
            "country_code": "US",
            "postal_code": "624012006",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "JESSICA",
            "last_name": "JATCKO",
            "middle_name": "JEAN",
            "prefix": "MS.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Effingham, IL

Sources for this page

Verify at the official NPI Registry.