Individual provider Active NPI

Jack David Sharratt, D.C.

  • Chiropractor
  • Batavia, IL
National Provider Identifier
1407809593
Registry record updated Feb 24, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
038-007729 Issued in IL
Practice address
940 W Wilson St
Batavia, IL 60510-1606
Phone
(630) 406-8088
NPI assigned
May 18, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 24, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 038-007729 IL Primary

Addresses

Primary practice location

940 W Wilson St
Batavia, IL 60510-1606

Mailing address

940 W Wilson St
Batavia, IL 60510-1606
Phone (630) 406-8088

Other identifiers 3

IdentifierTypeStateIssuer
038007729MedicaidIL
350055033OtherRAILROAD MEDICARE
4527042OtherILBLUE CROSS BLUE SHIELD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20101014000754 IL Practitioner - Chiropractic 3072705649 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
038-007729ILMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Sharratt Chiropractic LLC Chiropractor CurrentSince Apr 1, 2002 Accepting new patients
Ryan Brinka P.C. Chiropractor CurrentSince Jul 6, 2020 Accepting new patients

Locations

940 W Wilson St
Batavia, IL 60510
Phone (630) 406-8088

Organizations & group practices 2

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": "1147910400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1298505600000",
    "number": "1407809593",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "940 W WILSON ST",
            "city": "BATAVIA",
            "state": "IL",
            "postal_code": "605101606",
            "telephone_number": "630-406-8088"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "940 W WILSON ST",
            "city": "BATAVIA",
            "state": "IL",
            "postal_code": "605101606",
            "telephone_number": "630-406-8088"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHARRATT",
        "first_name": "JACK",
        "middle_name": "DAVID",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-18",
        "last_updated": "2011-02-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "IL",
            "license": "038-007729",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "038007729",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "350055033",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "4527042",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Batavia, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.