Family Medicine Specialists, S.C.

Primary specialty

Non-Pharmacy Dispensing SiteTaxonomy code 332900000X

Legal business name

FAMILY MEDICINE SPECIALISTS, S.C.

Doing business as

Family Medicine Specialists

Practice address

431 W Liberty Street
Wauconda, IL 60084

Phone

(847) 508-5897

Fax

(847) 526-2017

NPI assigned

Nov 25, 2015

Last updated

Nov 25, 2015By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Jasmine Worthen

Title

Credentialing Specialist

Phone

(727) 755-0693

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Family Medicine Specialists Doing business as

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jennifer M Bellucci Jackson, MD

  • Family Medicine Physician
  • Wauconda, IL
  • NPI 1689669293
  NPD

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

{
    "created_epoch": "1448409600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1448409600000",
    "number": "1366816514",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "311 PARK PLACE BLVD",
            "address_2": "5TH FLOOR",
            "city": "CLEARWATER",
            "state": "FL",
            "postal_code": "337594904",
            "telephone_number": "727-755-0693"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "431 W LIBERTY STREET",
            "city": "WAUCONDA",
            "state": "IL",
            "postal_code": "60084",
            "telephone_number": "847-508-5897",
            "fax_number": "847-526-2017"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY MEDICINE SPECIALISTS, S.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-11-25",
        "last_updated": "2015-11-25",
        "status": "A",
        "authorized_official_last_name": "WORTHEN",
        "authorized_official_first_name": "JASMINE",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "727-755-0693"
    },
    "taxonomies": [
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036083207",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Family Medicine Specialists",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Family Medicine Specialists, S.C.
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• Non-Pharmacy Dispensing Site in Wauconda, IL
• Providers in Wauconda, IL by specialty
• Non-Pharmacy Dispensing Site in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 25, 2015; 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.