Individual provider Active NPI

Jennifer Craig, O.D.

  • Optometrist
  • Carbondale, IL
National Provider Identifier
1376573022
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Practice address
1237 E Main St
A-35
Carbondale, IL 62901-3148
Phone
(618) 457-5520
Fax
(618) 457-5671
NPI assigned
Jul 4, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X IL Primary

Addresses

Primary practice location

1237 E Main St
A-35
Carbondale, IL 62901-3148

Mailing address

11103 West Ave
6
San Antonio, TX 78213-1370
Phone (210) 524-6663

Medicare participation

Medicare enrollment files
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: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060913000115 IL Practitioner - Optometry 7719981364 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
University of Missouri St Louis - School of Optometry, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
J Bass LTDGroup PAC ID 5193734960, 2 clinicians

Practice addresses (Care Compare)

112 S 42ND St
Mount Vernon, IL 62864-2243
Phone (618) 244-0508

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery34

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
046-009688ILMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
J Bass LTD Optometrist CurrentSince Oct 20, 2016 Accepting new patients

Locations

112 S 42nd St
Mount Vernon, IL 62864
Phone (618) 244-0508

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1151971200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1376573022",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11103 WEST AVE",
            "address_2": "6",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782131370",
            "telephone_number": "210-524-6663",
            "fax_number": "210-524-6587"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1237 E MAIN ST",
            "address_2": "A-35",
            "city": "CARBONDALE",
            "state": "IL",
            "postal_code": "629013148",
            "telephone_number": "618-457-5520",
            "fax_number": "618-457-5671"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CRAIG",
        "first_name": "JENNIFER",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-04",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Carbondale, IL

Sources for this page

Verify at the official NPI Registry.