Jack P Spaniol, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

036-07300 Issued in IL

Practice address

308 Saint Joseph Dr
Bloomington, IL 61701-3506

Phone

(309) 663-5050

Fax

(309) 662-3401

NPI assigned

Jun 29, 2006

Last updated

Mar 31, 2011By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Family Practice

Education

University of Illinois College of Med (CHI/Peor/Rock/CHM-Urb), 1985

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Advanced Physical Therapy Services, LTD.Group PAC ID 9133101462, shared by 5 NPIs, 216 clinicians

Osf Multi-Specialty GroupGroup PAC ID 3678889789, 2,123 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Osf Home Health-Eastern Region Home health agency, Bloomington, IL, CCN 147451
• St Joseph Medical Center Hospital, Bloomington, IL, CCN 140162
• Carle Bromenn Medical Center Hospital, Normal, IL, CCN 140127
• Saint James Hospital Hospital, Pontiac, IL, CCN 140161
• Saint Francis Medical Center Hospital, Peoria, IL, CCN 140067

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Osf Multi-Specialty Group

  • Internal Medicine Physician
  • Peoria, IL
  • NPI 1922445527
  Medicare reassignment Care Compare group NPD
• Central PA Pharmacy LLC.

  dba patton pharmacy and v&s variety

  • Community/Retail Pharmacy
  • Patton, PA
  • NPI 1578541413
  NPD
• Gibson Community Hospital Association

  dba Gibson Area Hospital and Health Services

  • Critical Access Hospital
  • Gibson City, IL
  • NPI 1114935681
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Carle Bromenn Medical Center

  dba Advocate BroMenn Medical Center

  • General Acute Care Hospital
  • Normal, IL
  • NPI 1962424036
  Care Compare affiliation
• Saint James Hospital

  dba Osf Saint James-John W Albrecht Medical Center

  • General Acute Care Hospital
  • Pontiac, IL
  • NPI 1407808090
  Care Compare affiliation
• St Joseph Medical Center

  dba OSF Saint Joseph Medical Center

  • General Acute Care Hospital
  • Bloomington, IL
  • NPI 1619916806
  Care Compare affiliation
• St Joseph Medical Center

  dba OSF Home Health-Eastern Region

  • Home Health Agency
  • Bloomington, IL
  • NPI 1851330203
  Care Compare affiliation

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

{
    "created_epoch": "1151539200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1301529600000",
    "number": "1356379184",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "308 SAINT JOSEPH DR",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617013506",
            "telephone_number": "309-663-5050",
            "fax_number": "309-662-3401"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "308 SAINT JOSEPH DR",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617013506",
            "telephone_number": "309-663-5050",
            "fax_number": "309-662-3401"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SPANIOL",
        "first_name": "JACK",
        "middle_name": "P",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-29",
        "last_updated": "2011-03-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036-07300",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Matthew R Sooby
• Cristian Sosa-Enamorado, DMD
• Diana Jane Souder, P.T.
• Shawn Soule, LCPC
• Matthew R Spangler, D.C.
• Ashleigh L Sparks
• Speech & Learning Connections
• Jennifer M. Speirer, FNP-C
• Brooke Spencer
• Latanya Rene Spiller, MMP, LMT

• Family Medicine Physician in Bloomington, IL
• Providers in Bloomington, IL by specialty
• Family Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2011; 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.