NPIMap

Individual provider Active NPI

Jeffrey Scott Tomlin, M.D.

  • Internal Medicine Physician
  • McHenry, IL
National Provider Identifier
1639163850
Registry record updated Jan 20, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
036.092485 Issued in IL
Practice address
3633 Municipal Dr
McHenry, IL 60050-5434
Phone
(779) 244-3072
Fax
(815) 331-8389
NPI assigned
Sep 2, 2005
Last updated
Jan 20, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 20, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 036092485 IL
Internal Medicine Physician 207R00000X 036.092485 IL Primary

Addresses

Primary practice location

3633 Municipal Dr
McHenry, IL 60050-5434

Mailing address

3633 Municipal Dr.
McHenry, IL 60050
Phone (779) 244-3072

Other identifiers 1

IdentifierTypeStateIssuer
036092485OtherILSTATE LICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040616000817 IL Practitioner - Internal Medicine 7012813413 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Indiana University School of Medicine, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

3633 Municipal Dr
McHenry, IL 60050-5434
Phone (779) 244-3072

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036.092485ILMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Fox Ridge Medical Associates, LLC Internal Medicine CurrentSince Apr 23, 2018 Accepting new patients
Fox Ridge Medical Associates, LLC CurrentSince Jul 17, 2018 Accepting new patients

Locations

3633 Municipal Dr
McHenry, IL 60050
Phone (779) 244-3072

Organizations & group practices 2

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.

Hospital & facility affiliations 8

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": "1125619200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1674172800000",
    "number": "1639163850",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3633 MUNICIPAL DR.",
            "city": "MCHENRY",
            "state": "IL",
            "postal_code": "60050",
            "telephone_number": "779-244-3072",
            "fax_number": "815-331-8389"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3633 MUNICIPAL DR",
            "city": "MCHENRY",
            "state": "IL",
            "postal_code": "600505434",
            "telephone_number": "779-244-3072",
            "fax_number": "815-331-8389"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TOMLIN",
        "first_name": "JEFFREY",
        "middle_name": "SCOTT",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-02",
        "last_updated": "2023-01-20",
        "certification_date": "2023-01-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036092485",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036.092485",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "036092485",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in McHenry, IL

Sources for this page

Verify at the official NPI Registry.