Jill Van Otterloo, PA
Individual provider Active NPI Physician Assistant · Forest City, IA
NPI 1679980783 · NPPES record last updated Jul 21, 2014
Key facts
- NPI
- 1679980783
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 074615 (IA)
- Practice address
- 635 E US Highway 9
Forest City, IA 50436-1028 - Phone
- (641) 585-2904
- Fax
- (641) 585-5417
- NPI assigned
- Jul 21, 2014
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20140819002789 | IA | Practitioner - Physician Assistant | 5597983395 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 074615 | IA | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sioux Center Health | Current |
Accepting new patients |
Locations
807 Main St
Ste D
Hull, IA 51239
Phone (712) 439-1315
1101 9th St SE
Sioux Center, IA 51250
Phone (712) 722-1271
Interoperability endpoints
- jill.vanotterloo@avera.sdhealthlink.net
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 074615 | IA | Yes |
Addresses
Primary practice location
635 E US Highway 9
Forest City, IA 50436-1028
Mailing address
621 S Illinois Ave
Suite 103
Mason City, IA 50401-5489
Phone (641) 428-3041
Other providers in Forest City, IA
- Lauren Schumacher
- Brooke Shefchik
- Shopko Stores Operating Co LLC
- The Evangelical Lutheran Good Samaritan Society
- Anne Tigges
- Samantha Lynn Wedemeier
- Pamela Jean Westendorf
- WHW County Social Services
- WHW County Social Services
- Wilson Dental Clinic, PLC
All providers in Forest City, IA · Physician Assistant in Iowa
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 21, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.