Individual provider Active NPI

Jillian Lynn Smith, DO

  • Family Medicine Physician
  • Davenport, IA
National Provider Identifier
1558980185
Registry record updated Aug 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
DO-55696 Issued in IA
Practice address
1345 W Central Park Ave
Davenport, IA 52804-1844
Phone
(563) 421-4400
Fax
(563) 421-4449
NPI assigned
Apr 14, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 13, 2026

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 036.171216 IL
Family Medicine Physician 207Q00000X DO-55696 IA Primary
Family Medicine Physician 207Q00000X DR.0070775 CO

Addresses

Primary practice location

1345 W Central Park Ave
Davenport, IA 52804-1844

Mailing address

1345 W Central Park Ave
Davenport, IA 52804-1844
Phone (563) 421-4400

Other practice location 1

1820 W 3rd St
Davenport, IA 52802-1812
Phone (563) 421-0500

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
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 1

Enrollment IDStateProvider typePAC IDDetails
I20240826000054 IL Practitioner - Family Practice 5597204305 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Midwestern University, Chicago College of Osteopathic Med, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Prime Healthcare Illinois Medical Group LLCGroup PAC ID 5597275685, 278 clinicians

Practice addresses (Care Compare)

100 N River Rd
Des Plaines, IL 60016-1209
Phone (847) 297-1800

7435 W Talcott Ave
Chicago, IL 60631-3707
Phone (773) 774-8000

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
DR.0070775COMDFamily Medicine Physician
036.171216ILMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Prime Healthcare Illinois Medical Group LLC Family Medicine CurrentSince Jul 14, 2025 Accepting new patients
Presence Healthcare Services Past Accepting new patients
Genesis Health System PastSince Aug 17, 2026 Accepting new patients

Locations

1801 W Olympic Blvd
#2637
Pasadena, CA 91199

1801 W Olympic Blvd
#2636
Pasadena, CA 91199

1325 N Highland Ave
Aurora, IL 60506
Phone (630) 801-2756

100 Provena Way
Ste 103
Bourbonnais, IL 60914
Phone (815) 937-8780

7435 W Talcott Ave
Ste 182
Chicago, IL 60631
Phone (773) 792-5154

7447 W Talcott Ave
Ste 182
Chicago, IL 60631
Phone (773) 594-7875

100 N River Rd
Des Plaines, IL 60016
Phone (847) 297-1800

201 N Hammes Ave
Joliet, IL 60435
Phone (224) 273-6350

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.

Hospital & facility affiliations 1

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": "1586822400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1786579200000",
    "number": "1558980185",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1345 W CENTRAL PARK AVE",
            "city": "DAVENPORT",
            "state": "IA",
            "postal_code": "528041844",
            "telephone_number": "563-421-4400",
            "fax_number": "563-421-4449"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1345 W CENTRAL PARK AVE",
            "city": "DAVENPORT",
            "state": "IA",
            "postal_code": "528041844",
            "telephone_number": "563-421-4400",
            "fax_number": "563-421-4449"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1820 W 3rd St",
            "address_purpose": "LOCATION",
            "city": "Davenport",
            "state": "IA",
            "postal_code": "528021812",
            "country_code": "US",
            "telephone_number": "563-421-0500",
            "fax_number": "563-326-1901",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SMITH",
        "first_name": "JILLIAN",
        "middle_name": "LYNN",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-04-14",
        "last_updated": "2026-08-13",
        "certification_date": "2026-08-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036.171216",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IA",
            "license": "DO-55696",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CO",
            "license": "DR.0070775",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Davenport, IA

Sources for this page

Verify at the official NPI Registry.