Individual provider Active NPI

D'Andrienne C. Jones, MD

  • Internal Medicine Physician
  • Alton, IL
National Provider Identifier
1760455661
Registry record updated Oct 22, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
036105039 Issued in IL
Practice address
2416 Bloomer Drive
Alton, IL 62002
Phone
(618) 465-9500
Fax
(618) 465-9502
NPI assigned
Feb 10, 2006
Last updated
Oct 22, 2011By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 22, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 036105039 IL Primary

Addresses

Primary practice location

2416 Bloomer Drive
Alton, IL 62002

Mailing address

2416 Bloomer Drive
Alton, IL 62002
Phone (618) 465-9500

Other identifiers 1

IdentifierTypeStateIssuer
0361050392MedicaidIL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
036105039ILMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Optimum Wellness and Rehabilitation PC CurrentSince Jan 1, 2017 Accepting new patients
Inpatient Consultants of Missouri Inc Internal Medicine Past Accepting new patients
Wilderman Chiropractic Center Inc PastSince Apr 1, 2016 Accepting new patients

Locations

3407 S State Route 157
Ste 1
Glen Carbon, IL 62034
Phone (618) 288-3610

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1139529600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1319241600000",
    "number": "1760455661",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2416 BLOOMER DRIVE",
            "city": "ALTON",
            "state": "IL",
            "postal_code": "62002",
            "telephone_number": "618-465-9500",
            "fax_number": "618-465-9502"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2416 BLOOMER DRIVE",
            "city": "ALTON",
            "state": "IL",
            "postal_code": "62002",
            "telephone_number": "618-465-9500",
            "fax_number": "618-465-9502"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JONES",
        "first_name": "D'ANDRIENNE",
        "middle_name": "C.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-02-10",
        "last_updated": "2011-10-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036105039",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0361050392",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Alton, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.