Individual provider Active NPI

Jennifer A Trickett, APRN, CNP

  • Nurse Practitioner
  • McHenry, IL
National Provider Identifier
1780338145
Registry record updated Jun 6, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
209024712 Issued in IL
Practice address
4309 W Medical Center Dr Ste B305
McHenry, IL 60050-8418
Phone
(847) 802-7400
Fax
(847) 802-7399
NPI assigned
Feb 4, 2022
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 6, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363L00000X 209.024712 IL
Nurse Practitioner 363L00000X 209024712 IL Primary

Addresses

Primary practice location

4309 W Medical Center Dr Ste B305
McHenry, IL 60050-8418

Mailing address

4309 W Medical Center Dr Ste B305
McHenry, IL 60050-8418
Phone (847) 802-7400

Other practice location 1

1465 Commerce Dr
Algonquin, IL 60102-5916
Phone (847) 802-7400

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
I20220711001842 IL Practitioner - Nurse Practitioner 9032597794 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Central Dupage Physician GroupGroup PAC ID 5890696231, 1,087 clinicians

Practice addresses (Care Compare)

4309 W Medical Ctr Dr
Suite B305
McHenry, IL 60050-8418
Phone (312) 695-3800

Hospital & facility affiliations

  • Northwestern Medicine McHenry Hospital, McHenry, IL, CCN 140116
  • Northwestern Medicine Central Dupage Hospital Hospital, Winfield, IL, CCN 140242
  • Northwestern Lake Forest Hospital Hospital, Lake Forest, IL, CCN 140130

Merit-based Incentive Payment System (MIPS)

Final score
95.63 of 100Reported as apm
Quality
88.47
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
209.024712ILMDNurse Practitioner
209024712ILMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Central Dupage Physician Group CurrentSince May 1, 2022 Accepting new patients
Central Dupage Physician Group Single Specialty CurrentSince May 1, 2022 Accepting new patients

Locations

1465 Commerce Dr
Algonquin, IL 60102
Phone (847) 802-7090

Dept 5777
Carol Stream, IL 60122

Carol Stream, IL 60122
Phone (630) 933-3300

4309 W Medical Center Dr
Ste B305
McHenry, IL 60050
Phone (847) 802-7400

1800 N Main St
Wheaton, IL 60187
Phone (630) 469-0045

Organizations & group practices 2

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.

Hospital & facility affiliations 4

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": "1643932800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1654473600000",
    "number": "1780338145",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4309 W MEDICAL CENTER DR STE B305",
            "city": "MCHENRY",
            "state": "IL",
            "postal_code": "600508418",
            "telephone_number": "847-802-7400",
            "fax_number": "847-802-7399"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4309 W MEDICAL CENTER DR STE B305",
            "city": "MCHENRY",
            "state": "IL",
            "postal_code": "600508418",
            "telephone_number": "847-802-7400",
            "fax_number": "847-802-7399"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1465 Commerce Dr",
            "address_purpose": "LOCATION",
            "city": "Algonquin",
            "state": "IL",
            "postal_code": "601025916",
            "country_code": "US",
            "telephone_number": "847-802-7400",
            "fax_number": "847-802-7399",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TRICKETT",
        "first_name": "JENNIFER",
        "middle_name": "A",
        "credential": "APRN, CNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-02-04",
        "last_updated": "2022-06-06",
        "certification_date": "2022-06-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner",
            "state": "IL",
            "license": "209.024712",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IL",
            "license": "209024712",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in McHenry, IL

Sources for this page

Verify at the official NPI Registry.