Jennifer Pablo Nepomuceno, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

036083314 Issued in IL

Practice address

475 Brown Blvd
Suite 106
Bourbonnais, IL 60914-2325

Phone

(815) 937-8786

Fax

(815) 937-2067

NPI assigned

Jul 14, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1152835200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1437175148",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "475 BROWN BLVD",
            "address_2": "SUITE 106",
            "city": "BOURBONNAIS",
            "state": "IL",
            "postal_code": "609142325",
            "telephone_number": "815-937-8786",
            "fax_number": "815-937-2067"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "475 BROWN BLVD",
            "address_2": "SUITE 106",
            "city": "BOURBONNAIS",
            "state": "IL",
            "postal_code": "609142325",
            "telephone_number": "815-937-8786",
            "fax_number": "815-937-2067"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NEPOMUCENO",
        "first_name": "JENNIFER",
        "middle_name": "PABLO",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-14",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036083314",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036083314",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Brock B Mullenbach, D.O.
• Pamela S. Munson, M.A. L.C.P.C.
• MX Behavioral Health SC
• Natural Health Remedies, LLC
• Nepomuceno Family Practice LLC
• Reynaldo Elazegui Nepomuceno, M.D.
• Melissa D Newell
• Nicholas Rutkowski, O.D. & Associates LLC
• Matthew Clark Nicholson, O.D.
• Casey L Nicole, MS, ATC

• Family Medicine Physician in Bourbonnais, IL
• Providers in Bourbonnais, 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 Jul 9, 2007; 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.