Active NPI
Renaldo A Jacques, M.D.
- Family Medicine Physician
- Peoria, IL
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 036081670
- Practice address
- 2321 N Wisconsin Avenue
Peoria, IL 61603-3172 - Phone
- (309) 680-7600
- Fax
- (309) 676-5506
- NPI assigned
- Feb 20, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 036081670 | IL | Primary |
Addresses
Primary practice location
2321 N Wisconsin Avenue
Peoria, IL 61603-3172
Mailing address
1701 W. Garden Street
Heartland Community Health Clinic
Peoria, IL 61605-3531
Phone (309) 680-7600
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 036081670 | Medicaid | IL |
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: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20080430000344 | IL | Practitioner - Family Practice | 9739268913 | Reassigns benefits to 4 organizations |
Care Compare profile
Medicare Care Compare- Specialty
- Family Practice
- Education
- University of Arizona College of Medicine, 1988
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
3591 Griffin Ave
Pekin, IL 61554-6258
Phone (309) 353-6301
5401 N Knoxville Ave
Peoria, IL 61614-5021
611 W Park St
Urbana, IL 61801-2501
Phone (888) 712-2753
815 Main St
Suite a
Peoria, IL 61602-1080
Phone (309) 672-4977
Hospital & facility affiliations
- Carle Home Care
- Carle Health Methodist Hospital
- Carle Health Pekin Hospital
- Carle Health Proctor Hospital
- Saint Francis Medical Center
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Carle Health Care Incorporated | Family Medicine | Current | Accepting new patients |
| Proctor Health Systems | Family Medicine | Current | Accepting new patients |
| Proctor Health Systems | Family Medicine | Current | Accepting new patients |
| Methodist Medical Center of Illinois | Current | Accepting new patients | |
| Methodist Medical Center of Illinois | Current | Accepting new patients | |
| Pekin Prohealth Inc | Family Medicine | Current | Accepting new patients |
| Methodist Medical Center of Illinois | Current | Accepting new patients |
Locations
600 S 13th St
Pekin, IL 61554
Phone (309) 347-1151
3591 Griffin Ave
Pekin, IL 61554
Phone (309) 353-1822
5401 N Knoxville Ave
Ste 400
Peoria, IL 61614
Phone (309) 691-6610
120 NE Glen Oak Ave
Ste 400
Peoria, IL 61603
Phone (309) 671-3519
221 NE Glen Oak Ave
#100
Peoria, IL 61636
815 Main St
Ste A1
Peoria, IL 61602
221 NE Glen Oak Ave
Peoria, IL 61636
Phone (309) 672-4281
815 Main St
Ste A
Peoria, IL 61602
Phone (309) 672-4986
611 W Park St
Urbana, IL 61801
Phone (217) 383-6941
Interoperability endpoints
- rjacquesmd388583@carlehiedirect.net
Organizations & group practices 7
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.
-
- Internal Medicine Physician
- Urbana, IL
- NPI 1154653947
Family Medicine, IL
-
- General Acute Care Hospital
- Peoria, IL
- NPI 1164474755
-
- Psychiatric Hospital Unit
- Peoria, IL
- NPI 1275583155
Hospital & facility affiliations 5
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- Home Health Agency
- Champaign, IL
- NPI 1891780615
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1140393600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1325030400000",
"number": "1477528974",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1701 W. GARDEN STREET",
"address_2": "HEARTLAND COMMUNITY HEALTH CLINIC",
"city": "PEORIA",
"state": "IL",
"postal_code": "616053531",
"telephone_number": "309-680-7600",
"fax_number": "309-676-5506"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2321 N WISCONSIN AVENUE",
"city": "PEORIA",
"state": "IL",
"postal_code": "616033172",
"telephone_number": "309-680-7600",
"fax_number": "309-676-5506"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACQUES",
"first_name": "RENALDO",
"middle_name": "A",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-02-20",
"last_updated": "2011-12-28",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "IL",
"license": "036081670",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "036081670",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Peoria, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 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.