Individual provider Active NPI

Thomas W Jensen, D.C, D.A.B.C.I.

  • Internist Chiropractor
  • Sterling, IL
National Provider Identifier
1487728424
Registry record updated Dec 21, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internist ChiropractorTaxonomy code 111NI0900X
License
038-005659 Issued in IL
Practice address
2002 E 5TH St
Sterling, IL 61081-3016
Phone
(815) 626-0270
Fax
(815) 626-0205
NPI assigned
Nov 20, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 21, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internist Chiropractor 111NI0900X 038-005659 IL Primary

Addresses

Primary practice location

2002 E 5TH St
Sterling, IL 61081-3016

Mailing address

2002 E 5TH St
Sterling, IL 61081-3016
Phone (815) 626-0270

Other identifiers 1

IdentifierTypeStateIssuer
038005659MedicaidIL

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20051205000771 IL Practitioner - Chiropractic 7517917388 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
National College of Chiropractic, 1986
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

2002 E 5TH St
Sterling, IL 61081-3016
Phone (815) 626-0270

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
038-005659ILMDInternist Chiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Jensen Chiropractic Clinic LTD Internist CurrentSince Jan 1, 1988 Accepting new patients

Locations

2002 E 5th St
Sterling, IL 61081
Phone (815) 625-7931

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": "1163980800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1356048000000",
    "number": "1487728424",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2002 E 5TH ST",
            "city": "STERLING",
            "state": "IL",
            "postal_code": "610813016",
            "telephone_number": "815-626-0270",
            "fax_number": "815-626-0205"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2002 E 5TH ST",
            "city": "STERLING",
            "state": "IL",
            "postal_code": "610813016",
            "telephone_number": "815-626-0270",
            "fax_number": "815-626-0205"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JENSEN",
        "first_name": "THOMAS",
        "middle_name": "W",
        "name_prefix": "Dr.",
        "credential": "D.C, D.A.B.C.I.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-20",
        "last_updated": "2012-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111NI0900X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Internist",
            "state": "IL",
            "license": "038-005659",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "038005659",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sterling, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.

Verify at the official NPI Registry.