Individual provider Active NPI

Erin Jackson

  • Speech-Language Pathologist
  • Batavia, IL
National Provider Identifier
1619351061
Registry record updated Nov 24, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
242.003532 Issued in IL
Practice address
700 W Fabyan Pkwy
Batavia, IL 60510-1269
Phone
(630) 879-4000
NPI assigned
Jul 15, 2015
Last updated
Nov 24, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 24, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X 242.003532 IL Primary

Addresses

Primary practice location

700 W Fabyan Pkwy
Batavia, IL 60510-1269

Mailing address

692 Thompson Ave
North Aurora, IL 60542-9129
Phone (630) 450-4686

Other names 1

  • Erin Geihm Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL NA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200724000440 IL Practitioner - Qualified Speech Language Pathologist 7214351188 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Qualified Speech Language Pathologist
Education
Midwestern University College of Dental Medicine, Glendale, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1001 E Wilson St
Suite 100
Batavia, IL 60510-3157
Phone (630) 761-0900

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
242.003532ILMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Therapy Care LTD Speech-Language Pathologist CurrentSince Jul 16, 2020 Accepting new patients

Locations

1001 E Wilson St
Ste 100
Batavia, IL 60510
Phone (630) 761-0900

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1436918400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1574553600000",
    "number": "1619351061",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "692 THOMPSON AVE",
            "city": "NORTH AURORA",
            "state": "IL",
            "postal_code": "605429129",
            "telephone_number": "630-450-4686"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 W FABYAN PKWY",
            "city": "BATAVIA",
            "state": "IL",
            "postal_code": "605101269",
            "telephone_number": "630-879-4000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "ERIN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-07-15",
        "last_updated": "2019-11-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "IL",
            "license": "242.003532",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "NA",
            "affiliation": "N",
            "address_1": "700 W Fabyan Pkwy",
            "city": "Batavia",
            "state": "IL",
            "country_code": "US",
            "postal_code": "605101269",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "ERIN",
            "last_name": "GEIHM",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Batavia, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 24, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.