Jacquelyn B Garrett, MD

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

R4G86 Issued in MO

Practice address

11125 Dunn Rd
Ste 411
Saint Louis, MO 63136-6132

Phone

(314) 355-7111

Fax

(314) 355-8604

NPI assigned

Sep 11, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Jacquelyn B Dilworth Former name

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in MO

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Duane Ardie Dilworth Jr., M.D.

  • Dermatology Physician
  • Saint Louis, MO
  • NPI 1730507617
  Medicare reassignment
• Erin Beth Yoffie, PA-C

  • Medical Physician Assistant
  • Saint Louis, MO
  • NPI 1053578294
  Medicare reassignment

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.

• Deluxe Dermatology LLC

  • Dermatology Physician
  • Saint Louis, MO
  • NPI 1922605906
  Medicare reassignment NPD
• Jacquelyn B. Garrett, M.D.

  • Dermatology Physician
  • Saint Louis, MO
  • NPI 1508480708
  NPD Authorized official

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

{
    "created_epoch": "1157932800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638316800000",
    "number": "1851495907",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11125 DUNN RD STE 411",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631366132",
            "telephone_number": "314-355-7111",
            "fax_number": "314-355-8604"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11125 DUNN RD",
            "address_2": "STE 411",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631366132",
            "telephone_number": "314-355-7111",
            "fax_number": "314-355-8604"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GARRETT",
        "first_name": "JACQUELYN",
        "middle_name": "B",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-09-11",
        "last_updated": "2021-12-01",
        "certification_date": "2021-12-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "MO",
            "license": "R4G86",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "203880802",
            "state": "MO"
        }
    ],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
            "affiliation": "Y",
            "affiliationName": "BJC HealthCare",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "11125 DUNN RD",
            "address_2": "STE 411",
            "city": "SAINT LOUIS",
            "state": "MO",
            "country_code": "US",
            "postal_code": "631366132",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "JACQUELYN",
            "last_name": "DILWORTH",
            "middle_name": "B",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Carliss Rene Garrett, ANP
• Ernest Edward Garrett III, LCSW, LICSW
• Florinda Kay Garrett, RN
• Grace Marie Garrett, ACNP
• Heather Vallhonrat Garrett, MD
• Jeremy S Garrett, MD
• Laura Mae Garrett, BCBA
• Lisa A Garrett, BSN
• Patrick F Garrett, M.D.
• Robert W Garrett, M.D.

• Dermatology Physician in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Dermatology Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.