Jeffrey Ryan Sparks, D.O.
Individual provider Active NPI Otolaryngology/Facial Plastic Surgery Physician · Macomb, IL
NPI 1780935197 · NPPES record last updated Feb 28, 2014
Key facts
- NPI
- 1780935197
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Otolaryngology/Facial Plastic Surgery Physician 207YX0905X
- License
- 036-132116 (IL)
- Practice address
- 515 E Grant St
Suite 113
Macomb, IL 61455-3368 - Phone
- (309) 833-6937
- NPI assigned
- Sep 25, 2012
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 16
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Otolaryngology
- Education
- At Still University of Health Sciences, College of Osteo Med, Kirksville, 2008
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- McDonough County Hospital District
Practice addresses (Care Compare)
515 E Grant St
Suite 113
Macomb, IL 61455-3315
Phone (309) 833-6937
Hospital & facility affiliations
- MC Donough District Hospital
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Melanoma (skin cancer) excision | 36 |
| Removal of skin lesions | 1-10 |
| Skin biopsy | 1-10 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20131031001267 | IL | Practitioner - Otolaryngology | 8123253044 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036-132116 | IL | MD | Otolaryngology/Facial Plastic Surgery Physician |
| 2009026507 | MO | MD | Otolaryngology/Facial Plastic Surgery Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| McDonough County Hospital District | Current | Accepting new patients | |
| McDonough County Hospital District | Current | Accepting new patients | |
| McDonough County Hospital District | Current | Accepting new patients | |
| McDonough County Hospital District | Current | Accepting new patients | |
| McDonough County Hospital District | Current | Accepting new patients | |
| McDonough County Hospital District | Current | Accepting new patients | |
| McDonough County Hospital District | Current |
Accepting new patients | |
| McDonough County Hospital District | Current |
Accepting new patients | |
| McDonough County Hospital District | Current | Accepting new patients | |
| McDonough County Hospital District | Past | Accepting new patients |
Locations
402 S Adams St
Carthage, IL 62321
Phone (217) 357-3131
525 E Grant St
Macomb, IL 61455
Phone (309) 836-1611
503 E Grant St
Macomb, IL 61455
Phone (309) 833-5917
515 E Grant St
Ste 113
Macomb, IL 61455
Phone (309) 833-6937
515 E Grant St
Ste 213
Macomb, IL 61455
Phone (309) 836-1700
515 E Grant St
Macomb, IL 61455
Phone (309) 837-2414
Interoperability endpoints
- https://fhir-myrecord.cerner.com/r4/9c9d3cdf-0f7f-4b63-979a-f711747b3e95/
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Otolaryngology/Facial Plastic Surgery Physician | 207YX0905X | 2009026507 | MO | |
| Otolaryngology/Facial Plastic Surgery Physician | 207YX0905X | 036-132116 | IL | Yes |
Addresses
Primary practice location
515 E Grant St
Suite 113
Macomb, IL 61455-3368
Mailing address
515 E Grant St
Suite 113
Macomb, IL 61455-3368
Phone (309) 833-6937
Other providers in Macomb, IL
- Jennifer Smith
- Mary L. Smith
- Tamara Marie Smith
- Casey Sue Sollenberger
- Jennifer Soucie
- Springfield Clinic LLP
- Springfield Clinic Macomb Lab
- Layne Stambaugh
- Christine M. Standard
- Craig A. Stear
All providers in Macomb, IL · Otolaryngology/Facial Plastic Surgery Physician in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 28, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.