NPIMap

Organization Active NPI

Jacquelyn Hall-Davis,M.D. LTD

  • Child & Adolescent Psychiatry Physician
  • O'Fallon, IL
National Provider Identifier
1699173542
Registry record updated Dec 9, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Child & Adolescent Psychiatry PhysicianTaxonomy code 2084P0804X
License
036080270 Issued in IL
Legal business name
JACQUELYN HALL-DAVIS,M.D. LTD
Practice address
1669 Windham Way
Suite B
O Fallon, IL 62269-3072
Phone
(618) 622-9240
Fax
(618) 622-9241
NPI assigned
Dec 9, 2014
Last updated
Dec 9, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 9, 2014

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

Authorized official

Name
Dr. Jacquelyn Hall-Davis, M.D.NPI 1619042124
Title
President
Phone
(618) 622-9240

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Child & Adolescent Psychiatry Physician 2084P0804X 036080270 IL Primary

Addresses

Primary practice location

1669 Windham Way
Suite B
O Fallon, IL 62269-3072

Mailing address

1669 Windham Way
Suite B
O Fallon, IL 62269-3072
Phone (618) 622-9240

Other identifiers 2

IdentifierTypeStateIssuer
540653OtherILTRICARE
036080270MedicaidIL

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1418083200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1418083200000",
    "number": "1699173542",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1669 WINDHAM WAY",
            "address_2": "SUITE B",
            "city": "O FALLON",
            "state": "IL",
            "postal_code": "622693072",
            "telephone_number": "618-622-9240",
            "fax_number": "618-622-9241"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1669 WINDHAM WAY",
            "address_2": "SUITE B",
            "city": "O FALLON",
            "state": "IL",
            "postal_code": "622693072",
            "telephone_number": "618-622-9240",
            "fax_number": "618-622-9241"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACQUELYN HALL-DAVIS,M.D. LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-12-09",
        "last_updated": "2014-12-09",
        "status": "A",
        "authorized_official_last_name": "HALL-DAVIS",
        "authorized_official_first_name": "JACQUELYN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "618-622-9240",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "IL",
            "license": "036080270",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE",
            "identifier": "540653",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036080270",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in O'Fallon, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.