Individual provider Active NPI

Dermot Connole Jinks, D.C.

  • Single Specialty Group
  • Peabody, MA
National Provider Identifier
1528161817
Registry record updated Oct 26, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Single Specialty GroupTaxonomy code 193400000X
License
X011848 Issued in NY
Practice address
49 Central St
Suite 1a
Peabody, MA 01960-4375
Phone
(978) 531-0202
Fax
(978) 532-7076
NPI assigned
Sep 5, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 26, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Single Specialty Group 193400000X X011848 NY Primary

Addresses

Primary practice location

49 Central St
Suite 1a
Peabody, MA 01960-4375

Mailing address

402 Rowland St
Ballston Spa, NY 12020-2684
Phone (518) 363-0202

Other identifiers 1

IdentifierTypeStateIssuer
Y36302OtherMABLUE CROSS BLUE SHIELD #

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110512000202 NY Practitioner - Chiropractic 4789585712 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Palmer College Chiropractic - West Sunnyvale, 1993
Medicare assignment
May accept Medicare assignment
Group practices
Adirondack Advanced Chiropractic, PCGroup PAC ID 1658329073, 2 clinicians

Practice addresses (Care Compare)

402 Rowland St
Ballston Spa, NY 12020-2684
Phone (518) 363-0202

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
011848NYMDMental Health Counselor
X011848NYMDSingle Specialty Group
1777MAMDOccupational Therapy Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Adirondack Advanced Chiropractic, PC Single Specialty CurrentSince Apr 10, 2011 Accepting new patients
Adio Chiropractic, PLLC Single Specialty PastSince Jan 10, 2015 Accepting new patients
Peabody Family Chiropractic, Inc. Single Specialty PastSince Sep 19, 2007 Accepting new patients

Locations

402 Rowland St
Ballston Spa, NY 12020
Phone (518) 363-0202

Organizations & group practices 3

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": "1157414400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1477440000000",
    "number": "1528161817",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "402 ROWLAND ST",
            "city": "BALLSTON SPA",
            "state": "NY",
            "postal_code": "120202684",
            "telephone_number": "518-363-0202",
            "fax_number": "518-363-0711"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "49 CENTRAL ST",
            "address_2": "SUITE 1A",
            "city": "PEABODY",
            "state": "MA",
            "postal_code": "019604375",
            "telephone_number": "978-531-0202",
            "fax_number": "978-532-7076"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JINKS",
        "first_name": "DERMOT",
        "middle_name": "CONNOLE",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-05",
        "last_updated": "2016-10-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "193400000X",
            "taxonomy_group": "",
            "desc": "Single Specialty",
            "state": "NY",
            "license": "X011848",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD #",
            "identifier": "Y36302",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Peabody, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2016; 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.