JMJ3 Heritage, L.L.C.

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

35355 Issued in IA

Legal business name

JMJ3 HERITAGE, L.L.C.

Practice address

3800 Commerce Blvd
Davenport, IA 52807-3495

Phone

(563) 322-1888

NPI assigned

Jan 2, 2014

Organization subpart

No

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

Authorized official

Name

Naomi Chelli, MD

Title

Organizer

Phone

(563) 508-5139

Specialties & licenses 1

Addresses

Other identifiers 2

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

{
    "created_epoch": "1388620800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1388620800000",
    "number": "1548681950",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3135 52ND AVENUE CT",
            "city": "BETTENDORF",
            "state": "IA",
            "postal_code": "527226953",
            "telephone_number": "563-508-5139",
            "fax_number": "563-359-3828"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3800 COMMERCE BLVD",
            "city": "DAVENPORT",
            "state": "IA",
            "postal_code": "528073495",
            "telephone_number": "563-322-1888"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JMJ3 HERITAGE, L.L.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-01-02",
        "last_updated": "2014-01-02",
        "status": "A",
        "authorized_official_last_name": "CHELLI",
        "authorized_official_first_name": "NAOMI",
        "authorized_official_title_or_position": "ORGANIZER",
        "authorized_official_telephone_number": "563-508-5139",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "General Practice",
            "state": "IA",
            "license": "35355",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ILLINOIS LICENSE",
            "identifier": "036111692",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IOWA LICENSE",
            "identifier": "35355",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 2, 2014; 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.