Gretchen Jones, PAC

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

085-002030 Issued in IL

Practice address

21W021 Par LN
Itasca, IL 60143-2487

Phone

(630) 220-4122

Fax

(888) 445-1991

NPI assigned

Sep 21, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

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

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Credentials

Physician Assistant

State licenses

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

{
    "created_epoch": "1158796800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1627344000000",
    "number": "1750480570",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21W021 PAR LN",
            "city": "ITASCA",
            "state": "IL",
            "postal_code": "601432487",
            "telephone_number": "630-220-4122",
            "fax_number": "888-445-1991"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21W021 PAR LN",
            "city": "ITASCA",
            "state": "IL",
            "postal_code": "601432487",
            "telephone_number": "630-220-4122",
            "fax_number": "888-445-1991"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JONES",
        "first_name": "GRETCHEN",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-21",
        "last_updated": "2021-07-27",
        "certification_date": "2021-07-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085-002030",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RURAL HEALTH ID#",
            "identifier": "CH8564",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ryan Jackson, COTA/L
• John a. Guerrieri D.D.S. LTD
• Cortney Johnson
• Jason Johnson
• Kalina Maria Johnson
• Joseph R. Sperlazzo D.D.S., P.C.
• Priya Josephselvam, RPT
• Tiffany Marie Kanzler
• Brian Keane
• Jason Keeler

• Physician Assistant in Itasca, IL
• Providers in Itasca, IL by specialty
• Physician Assistant in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2021; 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.