Active NPI
Jerica Renee Patek
- Speech-Language Pathologist
- O Fallon, IL
National Provider Identifier
1548890296
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 146013718
- Practice address
- 723 Insight Ave Ste 300
O Fallon, IL 62269-2193 - Phone
- (618) 607-0086
- NPI assigned
- Jan 22, 2020
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 146013718 | IL | Primary |
Addresses
Primary practice location
723 Insight Ave Ste 300
O Fallon, IL 62269-2193
Mailing address
524 Glendale Dr
Troy, IL 62294-1766
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 146013718 | IL | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| The Caring Group | Speech-Language Pathologist | Current | Accepting new patients |
Locations
723 Insight Ave
Ste 300
O Fallon, IL 62269
Phone (618) 607-0086
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": "1579651200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1579651200000",
"number": "1548890296",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "524 GLENDALE DR",
"city": "TROY",
"state": "IL",
"postal_code": "622941766"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "723 INSIGHT AVE STE 300",
"city": "O FALLON",
"state": "IL",
"postal_code": "622692193",
"telephone_number": "618-607-0086"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PATEK",
"first_name": "JERICA",
"middle_name": "RENEE",
"name_prefix": "Miss",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-01-22",
"last_updated": "2020-01-22",
"certification_date": "2020-01-22",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "IL",
"license": "146013718",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in O Fallon, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.