Jacqueline L Kannan, M.D.

Primary specialty

Rheumatology PhysicianTaxonomy code 207RR0500X

License

036-152551 Issued in IL

Practice address

4119 W Shamrock LN
McHenry, IL 60050-8268

Phone

(815) 398-9491

Fax

(815) 381-7498

NPI assigned

Mar 26, 2015

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Jacqueline L Vaidya Former name

Electronic endpoints 1

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kannan.jacqueline@ro.eclinicaldirect.com

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.

• Orthomidwest, PLLC

  • Orthopaedic Surgery Physician
  • Rockford, IL
  • NPI 1730136474

  Multi-Specialty

  Medicare reassignment NPD
• Orthomidwest, PLLC

  • Durable Medical Equipment & Medical Supplies
  • Buffalo Grove, IL
  • NPI 1043180839
  NPD

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

{
    "created_epoch": "1427328000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1640044800000",
    "number": "1588058606",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "BOX 78534",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532788534",
            "telephone_number": "815-398-9491",
            "fax_number": "815-381-7498"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4119 W SHAMROCK LN",
            "city": "MCHENRY",
            "state": "IL",
            "postal_code": "600508268",
            "telephone_number": "815-398-9491",
            "fax_number": "815-381-7498"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KANNAN",
        "first_name": "JACQUELINE",
        "middle_name": "L",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-03-26",
        "last_updated": "2021-12-21",
        "certification_date": "2021-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RR0500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Rheumatology",
            "state": "IL",
            "license": "036-152551",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "125073073",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Kannan.Jacqueline@ro.eclinicaldirect.com",
            "affiliation": "N",
            "endpointDescription": "eCW email address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "4119 W Shamrock Ln",
            "city": "McHenry",
            "state": "IL",
            "country_code": "US",
            "postal_code": "600508268",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "JACQUELINE",
            "last_name": "VAIDYA",
            "middle_name": "L",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Kattie Kamps
• Christine Kane
• Jaclyn Renee Kane, MSN, PMHNP-BC
• Hiejin Kang, MD
• Walter Kang, PHARMD
• Kanu Panchal MDSC
• Joseph Kappil, M.D.
• Suheyla Karaduman, MD
• Anoop H. Karna, M.D.
• Sandhya R Karna, MD

• Rheumatology Physician in McHenry, IL
• Providers in McHenry, IL by specialty
• Rheumatology Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.