Jacqueline D Keck

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

209-013552 Issued in IL

Practice address

841 N Galena Ave
Suite 200
Dixon, IL 61021-1568

Phone

(815) 285-2273

Fax

(815) 285-2276

NPI assigned

Nov 10, 2015

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

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

Merit-based Incentive Payment System (MIPS)

Final score

95.19 of 100Reported as apm

Quality

83.05

Promoting interoperability

100

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Central Dupage Physician Group

  • Family Medicine Physician
  • Carol Stream, IL
  • NPI 1033149844
  Medicare reassignment NPD
• Cepamerica Illinois LLP

  • Emergency Medicine Physician
  • Elgin, IL
  • NPI 1912283110
  Medicare reassignment NPD
• Northwestern Medical Faculty Foundation

  • Multi-Specialty Clinic/Center
  • Carol Stream, IL
  • NPI 1346235314
  Medicare reassignment NPD
• Valley Emergency Care Management, Inc.

  • Emergency Medicine Physician
  • Geneva, IL
  • NPI 1841395092
  Medicare reassignment NPD
• Central Dupage Physician Group

  • Orthopaedic Surgery Physician
  • Geneva, IL
  • NPI 1780012344
  NPD
• Cep America - Illinois, LLP

  • Emergency Medicine Physician
  • Aurora, IL
  • NPI 1164975371
  NPD
• Cepamerica Illinois LLP

  • Emergency Medicine Physician
  • Springfield, IL
  • NPI 1871360297
  NPD
• Northwestern Medical Faculty Foundation

  • Durable Medical Equipment & Medical Supplies
  • Chicago, IL
  • NPI 1417718479
  NPD
• Ortho Rehab Specialists PLLC

  • Physical Therapist
  • Rockford, IL
  • NPI 1891330882
  NPD (past)

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

{
    "created_epoch": "1447113600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1326411539",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "841 N GALENA AVE",
            "address_2": "SUITE 200",
            "city": "DIXON",
            "state": "IL",
            "postal_code": "610211568",
            "telephone_number": "815-285-2273",
            "fax_number": "815-285-2276"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "841 N GALENA AVE",
            "address_2": "SUITE 200",
            "city": "DIXON",
            "state": "IL",
            "postal_code": "610211568",
            "telephone_number": "815-285-2273",
            "fax_number": "815-285-2276"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1850 Gateway Dr",
            "address_purpose": "LOCATION",
            "city": "Sycamore",
            "state": "IL",
            "postal_code": "601783192",
            "country_code": "US",
            "telephone_number": "815-217-3252",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KECK",
        "first_name": "JACQUELINE",
        "middle_name": "D",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-11-10",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IL",
            "license": "209013552",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209-013552",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Katherine Shaw Bethea Hospital
• Katherine Shaw Bethea Hospital
• Katherine Shaw Bethea Hospital
• Katherine Shaw Bethea Hospital-DME
• Katherine Shaw Bethea Hospital-Snu
• Carlee Renee Kelly, LCSW
• Samantha Anne Kelly, BAMHP
• Stacie Kemp
• Jesse Paul Kent
• Stephanie Ann Kester

• Family Nurse Practitioner in Dixon, IL
• Providers in Dixon, IL by specialty
• Family Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.