Individual provider Active NPI

Fernanda N Jacobs, DNP, APRN, AGACNP-BC

  • Nurse Practitioner
  • McHenry, IL
National Provider Identifier
1730962580
Registry record updated Aug 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
209028349 Issued in IL
Practice address
4309 W Medical Center Dr Ste B301
McHenry, IL 60050-8439
Phone
(847) 535-6083
Fax
(847) 234-4336
NPI assigned
Aug 16, 2023
Last updated
Aug 6, 2024By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 6, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 209028349 IL Primary
Acute Care Nurse Practitioner 363LA2100X 209.028349 IL
Acute Care Nurse Practitioner 363LA2100X 041462060 IL

Addresses

Primary practice location

4309 W Medical Center Dr Ste B301
McHenry, IL 60050-8439

Mailing address

4309 W Medical Center Dr Ste B301
McHenry, IL 60050-8439
Phone (847) 535-6083

Other practice location 1

8201 E Riverside Blvd
Rockford, IL 61114-2300
Phone (815) 971-7000

Medicare participation

Medicare enrollment files
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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20231208000640 IL Practitioner - Nurse Practitioner 8921457573 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

10400 Haligus Rd
Huntley, IL 60142-9553

4201 W Medical Ctr Dr
McHenry, IL 60050-8409
Phone (815) 759-4323

515 Valley View Dr
Suite 201
Moline, IL 61265-6175
Phone (312) 695-0870

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
209.028349ILMDAcute Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Rockford Health Physicians CurrentSince Oct 30, 2023 Accepting new patients
RMH Pathologists, LTD Current Accepting new patients
Northwestern Medical Faculty Foundation CurrentSince Jun 24, 2024 Accepting new patients
Northwestern Medical Faculty Foundation CurrentSince Jun 24, 2024 Accepting new patients
Central Dupage Physician Group Past Accepting new patients
Apollo Hospitalist Group LLC PastSince Aug 1, 2023 Accepting new patients

Locations

Dept 5777
Carol Stream, IL 60122

29624 Network Pl
Chicago, IL 60673
Phone (608) 741-7652

660 N Westmoreland Rd
#302
Lake Forest, IL 60045

4309 W Medical Center Dr
Ste B301
McHenry, IL 60050
Phone (847) 535-6083

515 Valley View Dr
Ste 201
Moline, IL 61265
Phone (312) 695-0870

2300 N Rockton Ave
Rockford, IL 61103
Phone (815) 971-5510

2350 N Rockton Ave
Rockford, IL 61103
Phone (815) 971-2200

8201 E Riverside Blvd
Rockford, IL 61114
Phone (815) 971-4066

Organizations & group practices 6

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 1

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

NPI Registry JSON

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

{
    "created_epoch": "1692144000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722902400000",
    "number": "1730962580",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4309 W MEDICAL CENTER DR STE B301",
            "city": "MCHENRY",
            "state": "IL",
            "postal_code": "600508439",
            "telephone_number": "847-535-6083",
            "fax_number": "847-234-4336"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4309 W MEDICAL CENTER DR STE B301",
            "city": "MCHENRY",
            "state": "IL",
            "postal_code": "600508439",
            "telephone_number": "847-535-6083",
            "fax_number": "847-234-4336"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8201 E Riverside Blvd",
            "address_purpose": "LOCATION",
            "city": "Rockford",
            "state": "IL",
            "postal_code": "611142300",
            "country_code": "US",
            "telephone_number": "815-971-7000",
            "fax_number": "815-968-7830",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACOBS",
        "first_name": "FERNANDA",
        "middle_name": "N",
        "credential": "DNP, APRN, AGACNP-BC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-08-16",
        "last_updated": "2024-08-06",
        "certification_date": "2024-08-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IL",
            "license": "209028349",
            "primary": true
        },
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "IL",
            "license": "209.028349",
            "primary": false
        },
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "IL",
            "license": "041462060",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in McHenry, IL

Sources for this page

Verify at the official NPI Registry.