Individual provider Active NPI

Jason Jerome, PH.D., M.D.

  • Emergency Medicine Physician
  • O Fallon, IL
National Provider Identifier
1881055762
Registry record updated Jan 5, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
A151956 Issued in CA
Practice address
1 Saint Elizabeth Blvd
O Fallon, IL 62269-1099
Phone
(618) 234-2120
NPI assigned
Mar 18, 2016
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 5, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 036153182 IL
Emergency Medicine Physician 207P00000X A151956 CA Primary

Addresses

Primary practice location

1 Saint Elizabeth Blvd
O Fallon, IL 62269-1099

Mailing address

1 Saint Elizabeth Blvd
O Fallon, IL 62269-1099

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA, IL2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20200103001354 CA Practitioner - Emergency Medicine 1557654928 Reassigns benefits to 1 organization
I20201202002598 IL Practitioner - Emergency Medicine 1557654928 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Tulane University School of Medicine, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Cepamerica Illinois LLPGroup PAC ID 3274793633, 492 clinicians

Practice addresses (Care Compare)

9515 Holy Cross LN
Breese, IL 62230-3618
Phone (618) 526-5325

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
93.41 of 100Reported as group
Quality
86.81
Improvement activities
40
Cost
77.34

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A151956CAMDEmergency Medicine Physician
036153182ILMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Vituity - Illinois Auc LLP Emergency Medicine Current Accepting new patients
Pinnacle Emergency Physicians of Bakersfield, a Professional Corp Emergency Medicine CurrentSince Oct 30, 2019 Accepting new patients
Cepamerica Illinois LLP Emergency Medicine CurrentSince Dec 1, 2020 Accepting new patients
Pinnacle Emergency Physicians of Bakersfield, a Professional Corp Emergency Medicine Current Accepting new patients
Cepamerica Illinois LLP Emergency Medicine Current Accepting new patients
Vituity - Illinois Auc LLP Emergency Medicine CurrentSince Dec 1, 2020 Accepting new patients
Pinnacle Emergency Physicians of Bakersfield, a Professional Corp Emergency Medicine CurrentSince Oct 30, 2019 Accepting new patients
Cepamerica Illinois LLP Emergency Medicine CurrentSince Dec 1, 2020 Accepting new patients

Locations

420 34th St
Bakersfield, CA 93301
Phone (661) 324-4647

1601 Cummins Dr
Ste D
Modesto, CA 95358
Phone (510) 851-7423

801 W Temple Ave
Effingham, IL 62401
Phone (217) 342-5800

1 Saint Elizabeth Blvd
O Fallon, IL 62269
Phone 618234212012438

9515 Holy Cross Ln
Saint Rose, IL 62230
Phone (618) 526-4511

4500 Memorial Dr
Swansea, IL 62226
Phone (618) 233-7750

Organizations & group practices 8

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.

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": "1458259200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1609804800000",
    "number": "1881055762",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 SAINT ELIZABETH BLVD",
            "city": "O FALLON",
            "state": "IL",
            "postal_code": "622691099"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 SAINT ELIZABETH BLVD",
            "city": "O FALLON",
            "state": "IL",
            "postal_code": "622691099",
            "telephone_number": "618-234-2120"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JEROME",
        "first_name": "JASON",
        "name_prefix": "Dr.",
        "credential": "PH.D., M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-03-18",
        "last_updated": "2021-01-05",
        "certification_date": "2021-01-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "IL",
            "license": "036153182",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "CA",
            "license": "A151956",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in O Fallon, IL

Sources for this page

Verify at the official NPI Registry.