Jacqueline Marie Heffernan Ryaboy, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

036159064 Issued in IL

Practice address

9000 Waukegan Rd Ste 240
Morton Grove, IL 60053-2128

Phone

(847) 296-1177

Fax

(847) 296-6437

NPI assigned

May 27, 2015

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

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in MD

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

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Kaiser Foundation Health Plan of the Mid Atlantic States, Inc

  • Health Maintenance Organization
  • Halethorpe, MD
  • NPI 1043378656
  Medicare reassignment NPD
• Suburban Pediatrics, LTD.

  • Pediatrics Physician
  • Morton Grove, IL
  • NPI 1316952765
  NPD
• Kaiser Foundation Health Plan of the Mid Atlantic States, Inc

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Rockville, MD
  • NPI 1962108753
  NPD
• Advocate Lutheran General Hospital

  • Children's Hospital
  • Park Ridge, IL
  • NPI 1023308608
  NPD (past)

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

{
    "created_epoch": "1432684800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698192000000",
    "number": "1750760484",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9000 WAUKEGAN RD STE 240",
            "city": "MORTON GROVE",
            "state": "IL",
            "postal_code": "600532128",
            "telephone_number": "847-296-1177",
            "fax_number": "847-296-6437"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9000 WAUKEGAN RD STE 240",
            "city": "MORTON GROVE",
            "state": "IL",
            "postal_code": "600532128",
            "telephone_number": "847-296-1177",
            "fax_number": "847-296-6437"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RYABOY",
        "first_name": "JACQUELINE",
        "middle_name": "MARIE HEFFERNAN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-05-27",
        "last_updated": "2023-10-25",
        "certification_date": "2023-10-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IL",
            "license": "036159064",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepiceast.kp.org:14430/Interconnect-prodmam/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ceq",
            "affiliation": "N",
            "endpointDescription": "Carequality",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "9000 Waukegan Rd Ste 240",
            "city": "Morton Grove",
            "state": "IL",
            "country_code": "US",
            "postal_code": "600532128",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Blerim Rukaj
• Nicole Rupert, PHARMD
• Rxperts Pharmacy - Chicago, LLC
• S K Chiropractic & Rehab Corp.
• Milad Saad, DDS
• Aneta Sacha, FNP
• Amber Sadoski, BCBA
• Sanita Saengvilay

• Pediatrics Physician in Morton Grove, IL
• Providers in Morton Grove, IL by specialty
• Pediatrics Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2023; 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.