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
Sex
Female
Sole proprietor
Yes

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 and National Provider Directory roles.

Hospital & facility affiliations 15

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

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 Round Lake Incorporated S C 20 clinicians
Family Medicine Specialists of Mount Prospect S C 16 clinicians
Family Medicine Specialists S.C. 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

  • Advocate Home Health Care Serv Home health agency, Oakbrook, IL, CCN 147150
  • Meridian Home Health Care Services, Inc Home health agency, Libertyville, IL, CCN 148006
  • Centerwell Home Health II Home health agency, Buffalo Grove, IL, CCN 147979
  • Amedisys Home Health Home health agency, Lake Zurich, IL, CCN 147407
  • Aspire Home Healthcare, LLC Home health agency, Morton Grove, IL, CCN 148139
  • Journeycare - Barrington Hospice, Barrington, IL, CCN 141525
  • Northwestern Medicine McHenry Hospital, McHenry, IL, CCN 140116
  • Vista Medical Center East Hospital, Waukegan, IL, CCN 140084
  • Advocate Condell Medical Center Hospital, Libertyville, IL, CCN 140202
  • Northwestern Lake Forest Hospital Hospital, Lake Forest, IL, CCN 140130
  • Advocate Good Shepherd Hospital Hospital, Barrington, IL, CCN 140291

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

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.

Medicare enrollment records 1

Medicare enrollment files
Enrollment IDStateProvider typePAC IDDetails
I20100115000334 IL Practitioner - Family PracticePractitioner - General Surgery 5698817542 Reassigns benefits to 3 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
Flagged The directory lists this NPI on an HHS exclusion list. Confirm with the OIG exclusions search.
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 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
Family Medicine Specialists, S.C. Current 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

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

431 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

Specialties & licenses 1

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

Addresses

NPPES NPI Registry

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

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on May 23, 2023.

{
    "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.