Individual provider Active NPI

Jennifer Lynn Prather, MD

  • Anatomic Pathology & Clinical Pathology Physician
  • Davenport, IA
National Provider Identifier
1548436215
Registry record updated Jun 30, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
License
036.128044 Issued in IL
Practice address
1227 E Rusholme St
Genisis Medical Ctr, East Campus
Davenport, IA 52803-2459
Phone
(563) 421-6771
Fax
(563) 421-6770
NPI assigned
May 2, 2008
Last updated
Jun 30, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 30, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X 036.128044 IL Primary

Addresses

Primary practice location

1227 E Rusholme St
Genisis Medical Ctr, East Campus
Davenport, IA 52803-2459

Mailing address

1814 E Locust St
Davenport, IA 52803-2038
Phone (563) 324-0471

Other names 1

  • Jennifer Edwards Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jennifer.prather@direct.genesishealth.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL, IA2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20130701000145 IL Practitioner - Pathology 7719127422 Reassigns benefits to 1 organization
I20140212000601 IA Practitioner - Pathology 7719127422 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pathology
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Genesis Health SystemGroup PAC ID 7214841436, 217 clinicians

Practice addresses (Care Compare)

1227 E Rusholme St
Mercyone Genesis Davenport Patholog
Davenport, IA 52803-2459
Phone (563) 421-6610

855 Illini Dr
Suite 203
Silvis, IL 61282-2904
Phone (563) 421-6772

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
036.128044ILMDAnatomic Pathology & Clinical Pathology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Genesis Health System Anatomic Pathology & Clinical Pathology CurrentSince Apr 1, 2016 Accepting new patients
Genesis Health System CurrentSince Apr 1, 2016 Accepting new patients
Genesis Health System CurrentSince Apr 1, 2016 Accepting new patients
Metropolitan Medical Laboratory, PLC Past Accepting new patients

Locations

1227 E Rusholme St
Davenport, IA 52803
Phone (563) 324-8160

1401 W Central Park Ave
Davenport, IA 52804
Phone (563) 421-1900

210 W 53rd St
Davenport, IA 52806
Phone (563) 386-3436

619 5th St
Durant, IA 52747
Phone (563) 785-4487

202 Picard St
Alpha, IL 61413
Phone (309) 629-4601

306 46th Ave
East Moline, IL 61244
Phone (309) 796-2329

801 Illini Dr
Silvis, IL 61282
Phone (309) 281-4000

855 Illini Dr
Ste 203
Silvis, IL 61282
Phone (309) 281-4812

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1209686400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1625011200000",
    "number": "1548436215",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1814 E LOCUST ST",
            "city": "DAVENPORT",
            "state": "IA",
            "postal_code": "528032038",
            "telephone_number": "563-324-0471",
            "fax_number": "563-324-2498"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1227 E RUSHOLME ST",
            "address_2": "GENISIS MEDICAL CTR, EAST CAMPUS",
            "city": "DAVENPORT",
            "state": "IA",
            "postal_code": "528032459",
            "telephone_number": "563-421-6771",
            "fax_number": "563-421-6770"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRATHER",
        "first_name": "JENNIFER",
        "middle_name": "LYNN",
        "name_prefix": "Mrs.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-05-02",
        "last_updated": "2021-06-30",
        "certification_date": "2021-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "IL",
            "license": "036.128044",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jennifer.prather@direct.genesishealth.com",
            "affiliation": "N",
            "endpointDescription": "Genesis Health System Direct Email Address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCDA",
            "address_1": "1227 E Rusholme St",
            "address_2": "Genisis Medical Ctr, East Campus",
            "city": "Davenport",
            "state": "IA",
            "country_code": "US",
            "postal_code": "528032459",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "JENNIFER",
            "last_name": "EDWARDS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Davenport, IA

Sources for this page

Verify at the official NPI Registry.