NPIMap

Individual provider Active NPI

Jeffrey Ryan Sparks, D.O.

  • Otolaryngology/Facial Plastic Surgery Physician
  • Macomb, IL
National Provider Identifier
1780935197
Registry record updated Feb 28, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology/Facial Plastic Surgery PhysicianTaxonomy code 207YX0905X
License
036-132116 Issued in IL
Practice address
515 E Grant St
Suite 113
Macomb, IL 61455-3368
Phone
(309) 833-6937
NPI assigned
Sep 25, 2012
Last updated
Feb 28, 2014By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 28, 2014

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology/Facial Plastic Surgery Physician 207YX0905X 2009026507 MO
Otolaryngology/Facial Plastic Surgery Physician 207YX0905X 036-132116 IL Primary

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

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
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
I20131031001267 IL Practitioner - Otolaryngology 8123253044 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
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

Practice addresses (Care Compare)

515 E Grant St
Suite 113
Macomb, IL 61455-3315
Phone (309) 833-6937

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision36
Removal of skin lesions1-10
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036-132116ILMDOtolaryngology/Facial Plastic Surgery Physician
2009026507MOMDOtolaryngology/Facial Plastic Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
McDonough County Hospital District Current Accepting new patients
McDonough County Hospital District CurrentSince Aug 1, 2013 Accepting new patients
McDonough County Hospital District CurrentSince Aug 1, 2013 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

503 E Grant St
Macomb, IL 61455
Phone (309) 833-5917

515 E Grant St
Macomb, IL 61455
Phone (309) 833-6937

515 E Grant St
Ste 113
Macomb, IL 61455
Phone (309) 333-2439

515 E Grant St
Ste 213
Macomb, IL 61455
Phone (309) 836-1700

525 E Grant St
Macomb, IL 61455
Phone (309) 836-1611

Interoperability endpoints

  • FHIR API: https://fhir-myrecord.cerner.com/r4/9c9d3cdf-0f7f-4b63-979a-f711747b3e95/

Organizations & group practices 10

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 1

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": "1348531200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1393545600000",
    "number": "1780935197",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "515 E GRANT ST",
            "address_2": "SUITE 113",
            "city": "MACOMB",
            "state": "IL",
            "postal_code": "614553368",
            "telephone_number": "309-833-6937"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "515 E GRANT ST",
            "address_2": "SUITE 113",
            "city": "MACOMB",
            "state": "IL",
            "postal_code": "614553368",
            "telephone_number": "309-833-6937"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SPARKS",
        "first_name": "JEFFREY",
        "middle_name": "RYAN",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-09-25",
        "last_updated": "2014-02-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207YX0905X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Otolaryngology/Facial Plastic Surgery",
            "state": "MO",
            "license": "2009026507",
            "primary": false
        },
        {
            "code": "207YX0905X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Otolaryngology/Facial Plastic Surgery",
            "state": "IL",
            "license": "036-132116",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Macomb, IL

Sources for this page

Verify at the official NPI Registry.