Jamie Lynn Fitterer

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

180.008145 Issued in IL

Practice address

2266 Madison Ave
Granite City, IL 62040-4705

Phone

(618) 877-1184

Fax

(618) 798-4287

NPI assigned

Jul 23, 2012

Last updated

Jul 23, 2012By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Feb 12, 2024 through Feb 12, 2028

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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.

• Grounded Life Therapy Solutions

  • Professional Counselor
  • Saint Charles, MO
  • NPI 1699495598
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1343001600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1343001600000",
    "number": "1831444116",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2266 MADISON AVE",
            "city": "GRANITE CITY",
            "state": "IL",
            "postal_code": "620404705",
            "telephone_number": "618-877-1184",
            "fax_number": "618-798-4287"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2266 MADISON AVE",
            "city": "GRANITE CITY",
            "state": "IL",
            "postal_code": "620404705",
            "telephone_number": "618-877-1184",
            "fax_number": "618-798-4287"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FITTERER",
        "first_name": "JAMIE",
        "middle_name": "LYNN",
        "name_prefix": "Mrs.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-07-23",
        "last_updated": "2012-07-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "IL",
            "license": "180.008145",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Fresenius Medical Care of Illinois, LLC (Fresenius Kidney Care Madison County)

• Professional Counselor in Granite City, IL
• Providers in Granite City, IL by specialty
• Professional Counselor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.