JLR Family Practice, PC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

01047337A Issued in IN

Legal business name

JLR FAMILY PRACTICE, PC

Practice address

3404 Newton St
Jasper, IN 47546-1020

Phone

(812) 634-7726

NPI assigned

Jul 5, 2007

Organization subpart

No

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

Authorized official

Name

Jennifer Lynn RichardsonNPI 1740374826

Title

President

Phone

(812) 634-7726

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in IN

Enrollment records 1

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jennifer Lynn Richardson, M.D.

  • Family Medicine Physician
  • Jasper, IN
  • NPI 1740374826
  Medicare reassignment Authorized official
• Mallory Breanne Libbert, M.S., CCC-SLP

  • Speech-Language Pathologist
  • Jasper, IN
  • NPI 1619686391
  NPD (past)
• Whitney Scraper

  • Speech-Language Pathologist
  • Jasper, IN
  • NPI 1871071001
  NPD (past)

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

{
    "created_epoch": "1183593600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208563200000",
    "number": "1710185319",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3404 NEWTON ST",
            "city": "JASPER",
            "state": "IN",
            "postal_code": "475461020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3404 NEWTON ST",
            "city": "JASPER",
            "state": "IN",
            "postal_code": "475461020",
            "telephone_number": "812-634-7726"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JLR FAMILY PRACTICE, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-05",
        "last_updated": "2008-04-19",
        "status": "A",
        "authorized_official_last_name": "RICHARDSON",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "812-634-7726"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "01047337A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200227510B",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jasper SNF Opco LLC
• Jasper Surgical Associates
• Jasper Surgical Associates LLC
• Myrissa Jolene Jernigan
• Jesc LLC
• Brooke Johnson
• Catherine Van Natta Jones, P.T.
• Kiley Jeanne Jones
• Rodney Randall Kalb, D.D.S.
• Mary Susan Kaminski

• Family Medicine Physician in Jasper, IN
• Providers in Jasper, IN by specialty
• Family Medicine Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.