NPIMap

Individual provider Active NPI

Jennifer Kristin Thill, MD

  • Family Medicine Physician
  • Omak, WA
National Provider Identifier
1770666281
Registry record updated Sep 11, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MD00047900 Issued in WA
Practice address
810 Jasmine St
Omak, WA 98841-9578
Phone
(509) 826-1760
Fax
(509) 826-7211
NPI assigned
Oct 21, 2006
Last updated
Sep 11, 2013By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X MD00047900 WA Primary

Addresses

Primary practice location

810 Jasmine St
Omak, WA 98841-9578

Mailing address

PO Box 793
Omak, WA 98841-9578
Phone (509) 826-1760

Other identifiers 3

IdentifierTypeStateIssuer
0222348OtherWAL&I
8944672OtherWACV
8484529MedicaidWA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070817000184 WA Practitioner - Family PracticePractitioner - Emergency Medicine 3971695172 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family PracticeAlso: Emergency Medicine
Education
University of Texas Medical Branch at Galveston, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

529 Jasmine St
Omak, WA 98841-9589
Phone (509) 826-1800

810 Jasmine St
Omak, WA 98841-9578
Phone (509) 826-1760

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD00047900WAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Okanogan County Public Hospital District No. 3 CurrentSince Aug 12, 2013 Accepting new patients
Okanogan County Public Hospital District No. 3 Family Medicine Current Accepting new patients
Wfubmccp Primary Care, LLC Past Accepting new patients
MBB Brewster LLC Past Accepting new patients

Locations

529 Jasmine St
Omak, WA 98841
Phone (509) 826-1600

810 Jasmine St
Omak, WA 98841
Phone (509) 826-1760

916 Koala Dr
Omak, WA 98841
Phone (509) 826-1800

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Enhabit HospiceOmak, WA, CCN 501536 Hospice Contracted Managing Employee Jun 1, 2021

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

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.

Hospital & facility affiliations 7

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": "1161388800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1378857600000",
    "number": "1770666281",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 793",
            "city": "OMAK",
            "state": "WA",
            "postal_code": "988419578",
            "telephone_number": "509-826-1760",
            "fax_number": "509-826-7211"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "810 JASMINE ST",
            "city": "OMAK",
            "state": "WA",
            "postal_code": "988419578",
            "telephone_number": "509-826-1760",
            "fax_number": "509-826-7211"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THILL",
        "first_name": "JENNIFER",
        "middle_name": "KRISTIN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-21",
        "last_updated": "2013-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "MD00047900",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "L&I",
            "identifier": "0222348",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CV",
            "identifier": "8944672",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8484529",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Omak, WA

Sources for this page

Verify at the official NPI Registry.