NPIMap

Individual provider Active NPI

Jennifer M Bellucci Jackson, MD

  • Family Medicine Physician
  • Wauconda, IL
National Provider Identifier
1689669293
Registry record updated May 23, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
036083207 Issued in IL
Practice address
431 W Liberty St
Wauconda, IL 60084-2452
Phone
(847) 526-2151
Fax
(847) 526-2017
NPI assigned
Sep 20, 2005
Last updated
May 23, 2023By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 23, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 036083207 IL Primary

Addresses

Primary practice location

431 W Liberty St
Wauconda, IL 60084-2452

Mailing address

PO Box 6037
431 W Liberty St
Wauconda, IL 60084-6037
Phone (847) 526-2151

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
I20100115000334 IL Practitioner - Family PracticePractitioner - General Surgery 5698817542 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Chicago College of Medicine and Surgery, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Family Medicine Specialists of Mount Prospect S CGroup PAC ID 8224166566, 16 clinicians
Family Medicine Specialists S.C.Group PAC ID 0042206252, 24 clinicians

Practice addresses (Care Compare)

2680 N Il Route 83
Round Lake Beach, IL 60073-4983
Phone (224) 372-7780

3801 Running Brook Farm Blvd
Johnsburg, IL 60051-5425
Phone (815) 344-7741

431 W Liberty St
Wauconda, IL 60084-2452
Phone (847) 526-2151

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
82.98 of 100Reported as individual
Quality
51.94
Promoting interoperability
89
Improvement activities
40
Cost
78.82

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Family Medicine Specialists, S.C. Family Medicine CurrentSince Aug 1, 1995 Accepting new patients
Family Medicine Specialists, S.C. Current Accepting new patients
Family Medicine Specialists of Mount Prospect S C Family Medicine CurrentSince Aug 1, 2009 Accepting new patients
Family Medicine Specialists of Round Lake Incorporated S C Family Medicine CurrentSince Dec 29, 2012 Accepting new patients

Locations

425 Lake St
Antioch, IL 60002
Phone (244) 538-9736

2253 N Richmond Rd
McHenry, IL 60051
Phone (847) 526-2151

3801 Running Brook Farm Blvd
McHenry, IL 60051
Phone (815) 344-7741

9700 N Main St
Richmond, IL 60071
Phone (815) 678-4181

2680 State Route 83
Round Lake Beach, IL 60073
Phone (224) 372-7780

431 W Liberty St
Wauconda, IL 60084
Phone (847) 526-2151

604 W Liberty St
Wauconda, IL 60084
Phone (847) 526-2151

909 Belvidere Rd
Waukegan, IL 60085
Phone (847) 244-4995

4000 Il Route 173
Zion, IL 60099
Phone (847) 731-8172

Interoperability endpoints

  • Direct secure messaging: jennifer.bellucci@fms.eclinicaldirectplus.com

Organizations & group practices 4

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 15

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1127174400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1684800000000",
    "number": "1689669293",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 6037",
            "address_2": "431 W LIBERTY ST",
            "city": "WAUCONDA",
            "state": "IL",
            "postal_code": "600846037",
            "telephone_number": "847-526-2151",
            "fax_number": "847-526-2017"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "431 W LIBERTY ST",
            "city": "WAUCONDA",
            "state": "IL",
            "postal_code": "600842452",
            "telephone_number": "847-526-2151",
            "fax_number": "847-526-2017"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BELLUCCI JACKSON",
        "first_name": "JENNIFER",
        "middle_name": "M",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-09-20",
        "last_updated": "2023-05-23",
        "certification_date": "2023-05-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036083207",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wauconda, IL

Sources for this page

Verify at the official NPI Registry.