Individual provider Active NPI

Jennifer L Thomas, M.D.

  • Family Medicine Physician
  • Braidwood, IL
National Provider Identifier
1811181712
Registry record updated May 16, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
036124327 Issued in IL
Practice address
389 E Main St
Braidwood, IL 60408-2010
Phone
(815) 458-2532
Fax
(815) 458-2455
NPI assigned
Sep 4, 2007
Last updated
May 16, 2017By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 16, 2017

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 036124327 IL Primary

Addresses

Primary practice location

389 E Main St
Braidwood, IL 60408-2010

Mailing address

201 S Wabena Ave
Suite 2B
Minooka, IL 60447-8715
Phone (815) 941-9124

Other identifiers 1

IdentifierTypeStateIssuer
036124327MedicaidIL

Other names 1

  • Jennifer L Gruneich Former name

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100104000702 IL Practitioner - Family Practice 7719028398 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Southern Illinois University School of Medicine, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Morris HospitalGroup PAC ID 1850372459, 115 clinicians

Practice addresses (Care Compare)

101 S Prairie Ave
Dwight, IL 60420-1350
Phone (815) 584-3291

1300 Dresden Dr
Morris, IL 60450-2476
Phone (815) 942-5200

150 W High St
Morris, IL 60450-1463
Phone (815) 942-2932

389 E Main St
Braidwood, IL 60408-2010
Phone (815) 458-2532

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Morris Hospital Family Medicine CurrentSince Sep 1, 2010 Accepting new patients
Morris Hospital Current Accepting new patients
Morris Hospital CurrentSince Sep 1, 2010 Accepting new patients
Morris Hospital Current Accepting new patients
Gibson Community Hospital Association Past Accepting new patients

Locations

389 E Main St
Braidwood, IL 60408
Phone (815) 458-2532

25259 S Reed St
Channahon, IL 60410
Phone (815) 467-0555

409 N State Route 53
Gardner, IL 60424
Phone (815) 237-0413

580 Sycamore St
Marseilles, IL 61341
Phone (815) 795-2122

150 W High St
Morris, IL 60450
Phone (815) 942-2129

725 School St
Ste A
Morris, IL 60450

Interoperability endpoints

  • Direct secure messaging: jennifer.thomas.1@14307.direct.athenahealth.com
  • Direct secure messaging: jennifer.thomas@direct-address.org

Organizations & group practices 5

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 3

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": "1188864000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1494892800000",
    "number": "1811181712",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 S WABENA AVE",
            "address_2": "SUITE 2B",
            "city": "MINOOKA",
            "state": "IL",
            "postal_code": "604478715",
            "telephone_number": "815-941-9124",
            "fax_number": "815-941-9128"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "389 E MAIN ST",
            "city": "BRAIDWOOD",
            "state": "IL",
            "postal_code": "604082010",
            "telephone_number": "815-458-2532",
            "fax_number": "815-458-2455"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THOMAS",
        "first_name": "JENNIFER",
        "middle_name": "L",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-09-04",
        "last_updated": "2017-05-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036124327",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036124327",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JENNIFER",
            "last_name": "GRUNEICH",
            "middle_name": "L",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Braidwood, IL

Sources for this page

Verify at the official NPI Registry.