Jeffrey R Barra, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

036107295 Issued in IL

Practice address

5100 Lake Ter NE
Suite WC
Mount Vernon, IL 62864-9665

Phone

(618) 899-5001

Fax

(618) 242-5152

NPI assigned

Feb 22, 2006

Last updated

May 13, 2015By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 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

Practice roles

Locations

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.

• Premise Health of Illinois Medical PC

  dba Mount Vernon Health Center Mt Vernon

  • Primary Care Clinic/Center
  • Mount Vernon, IL
  • NPI 1427366921
  Medicare reassignment NPD
• Premise Health of Illinois Medical PC

  dba MCL Health Center - Utica

  • Multi-Specialty Clinic/Center
  • Utica, IL
  • NPI 1295518868
  NPD
• Premise Health of Illinois Medical, PC

  dba Walgreens Healthy Living Center Deerfield

  • Primary Care Clinic/Center
  • Deerfield, IL
  • NPI 1033494976
  NPD (past)

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

{
    "created_epoch": "1140566400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1431475200000",
    "number": "1679548713",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5100 LAKE TER NE",
            "address_2": "SUITE WC",
            "city": "MOUNT VERNON",
            "state": "IL",
            "postal_code": "628649665",
            "telephone_number": "618-899-5001",
            "fax_number": "618-242-5152"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5100 LAKE TER NE",
            "address_2": "SUITE WC",
            "city": "MOUNT VERNON",
            "state": "IL",
            "postal_code": "628649665",
            "telephone_number": "618-899-5001",
            "fax_number": "618-242-5152"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BARRA",
        "first_name": "JEFFREY",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-22",
        "last_updated": "2015-05-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036107295",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036107295",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Whitney Baldridge, BA, MHP
• Allison Baldwin
• Julia W Balsover
• Krista Barber, LPC, ASOTP
• Teresa L Barnfield, MS LCPC
• Becca Barth, CPNP-PC
• Amy Elizabeth Barton, L.C.S.W.
• Jennifer K Bass, OD
• Amanda Lyn Bathon, CD
• Lindsey Bearden, RN

• Family Medicine Physician in Mount Vernon, IL
• Providers in Mount Vernon, IL by specialty
• Family Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2015; 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.