Jacquelyn M Herbert
Individual provider Active NPI Physician Assistant · Galesburg, IL
NPI 1922436682 · NPPES record last updated Apr 11, 2023
Key facts
- NPI
- 1922436682
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 085004892 (IL)
- Practice address
- 3315 N Seminary St
Galesburg, IL 61401-1251 - Phone
- (309) 344-1000
- Fax
- (309) 344-2405
- NPI assigned
- Oct 16, 2013
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 19
Hospital & facility affiliations 4
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Southern Illinois University School of Medicine, 2013
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- St Mary Medical Center
Advanced Physical Therapy Services, LTD.
Practice addresses (Care Compare)
104 S Broadway St
Knoxville, IL 61448
Phone (309) 289-2335
300 Tenney St
Kewanee, IL 61443-3452
Phone (309) 853-5500
904 E Main St
Osf Healthcare Medical Group Knoxville
Knoxville, IL 61448-1539
Phone (309) 289-2335
Hospital & facility affiliations
- Osf Home Health-Western Region
- Western Ill Home HLTH Care in
- St Mary Medical Center
- Osf Holy Family Medical Center
- Saint Francis Medical Center
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20131114002039 | IL | Practitioner - Physician Assistant | 1850527169 | Reassigns benefits to 3 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 085004892 | IL | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| St. Mary Medical Center | Current |
Accepting new patients | |
| Central PA Pharmacy LLC. | Current | Accepting new patients | |
| Osf Healthcare System | Current |
Accepting new patients | |
| Osf Multi-Specialty Group | Current |
Accepting new patients | |
| Osf Healthcare System | Current |
Accepting new patients | |
| St Mary Medical Center | Past | Accepting new patients |
Locations
3375 N Seminary St
Galesburg, IL 61401
Phone (309) 343-5114
3315 N Seminary St
Galesburg, IL 61401
Phone (309) 344-1000
904 E Main St
Knoxville, IL 61448
Phone (309) 289-2335
1000 W Harlem Ave
Monmouth, IL 61462
Phone (309) 734-1414
8600 State Route 91
Ste 130
Peoria, IL 61615
Phone (309) 683-5050
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 085004892 | IL | Yes |
Addresses
Primary practice location
3315 N Seminary St
Galesburg, IL 61401-1251
Mailing address
3315 N Seminary St
Galesburg, IL 61401-1251
Phone (309) 344-1000
Other names
- Jacquelyn M Spence
Other providers in Galesburg, IL
- Heartland of Galesburg Il, LLC
- Shelly Heimann
- Henderson-Knox-Mercer-Warren Regional Office of Education #33
- Angela Hendrickson
- Sharon Hensley
- Kate Herbert
- Justin Hering
- Jeffrey D Hershkowitz
- Robert Hickerson
- Kevin D Hickey
All providers in Galesburg, IL · Physician Assistant in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 11, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.