Jaclyn Kay Anderson, DO, MS

Primary specialty

Rheumatology PhysicianTaxonomy code 207RR0500X

License

036.125386 Issued in IL

Practice address

200 Abbott Park Rd
Dept. R4Ne, BLDG. Ap34-2
Abbott Park, IL 60064-6187

Phone

(847) 938-0133

NPI assigned

Jun 27, 2006

Last updated

Oct 1, 2010By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Credentials

Doctor of Osteopathy, Master of Science

State licenses

Practice roles

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.

• Mercy Hospital, Iowa City, Iowa

  dba Mercy Iowa City Professional Services

  • Emergency Medicine Physician
  • Iowa City, IA
  • NPI 1124089347

  Internal Medicine

  NPD (past)

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

{
    "created_epoch": "1151366400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1285891200000",
    "number": "1316974041",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 ABBOTT PARK RD",
            "address_2": "DEPT. R4NE, BLDG. AP34-2",
            "city": "ABBOTT PARK",
            "state": "IL",
            "postal_code": "600646187",
            "telephone_number": "847-938-0133"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 ABBOTT PARK RD",
            "address_2": "DEPT. R4NE, BLDG. AP34-2",
            "city": "ABBOTT PARK",
            "state": "IL",
            "postal_code": "600646187",
            "telephone_number": "847-938-0133"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDERSON",
        "first_name": "JACLYN",
        "middle_name": "KAY",
        "name_prefix": "Dr.",
        "credential": "DO, MS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-27",
        "last_updated": "2010-10-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IA",
            "license": "3715",
            "primary": false
        },
        {
            "code": "207RR0500X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Rheumatology",
            "state": "NE",
            "license": "5874",
            "primary": false
        },
        {
            "code": "207RR0500X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Rheumatology",
            "state": "IL",
            "license": "036.125386",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLMARK BCBS",
            "identifier": "26707",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0727701",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Genious Chaudhry, R.PH.
• Shari Beth Glynn, D.O.
• Robert G Hoff, M.D.
• Jeffrey M Leiden, M.D.
• Laura Ann Williams, MD, MPH

• Rheumatology Physician in Abbott Park, IL
• Providers in Abbott Park, IL by specialty
• Rheumatology Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.