Jasmine Pramoj Acfalle

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

125.084698 Issued in IL

Practice address

815 Main St Ste C
Peoria, IL 61602-1080

Phone

(309) 672-4986

NPI assigned

Apr 8, 2024

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

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

State licenses

Interoperability endpoints

• Direct secure messaging: jacfalledo411996@carlehiedirect.net

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

{
    "created_epoch": "1712534400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721088000000",
    "number": "1699528174",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "815 MAIN ST STE C",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616021080",
            "telephone_number": "309-672-4986"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "815 MAIN ST STE C",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616021080",
            "telephone_number": "309-672-4986"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ACFALLE",
        "first_name": "JASMINE",
        "middle_name": "PRAMOJ",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-04-08",
        "last_updated": "2024-07-16",
        "certification_date": "2024-07-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "125.084698",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": "0000000000000",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Access Dental of Peoria Vogue PLLC
• Accolade Healthcare of Peoria, LLC
• Accolade Healthcare of Peoria, LLC
• Accuquest Hearing Center, LLC
• Accurate Hearcare Corporation
• Jonathan Acklie, PT
• Acpm Podiatry Group, LTD
• Action Mobility Inc
• Active Way Healthcare Services, LLC
• Acute Care Surgery Midwest, S.C.

• All providers in Peoria, IL
• Family Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2024; 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.