Jessica Dineen, RSA

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

238000804 Issued in IL

Practice address

19015 S Jodi Rd Ste H
Mokena, IL 60448-8534

Phone

(708) 995-5418

Fax

(832) 804-8886

NPI assigned

Mar 27, 2024

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1711497600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1711497600000",
    "number": "1942051248",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19015 S JODI RD STE H",
            "city": "MOKENA",
            "state": "IL",
            "postal_code": "604488534",
            "telephone_number": "708-995-5418",
            "fax_number": "832-804-8886"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19015 S JODI RD STE H",
            "city": "MOKENA",
            "state": "IL",
            "postal_code": "604488534",
            "telephone_number": "708-995-5418",
            "fax_number": "832-804-8886"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DINEEN",
        "first_name": "JESSICA",
        "credential": "RSA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-03-27",
        "last_updated": "2024-03-27",
        "certification_date": "2024-03-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "IL",
            "license": "238000804",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Surgical Physician Assistant in Mokena, IL
• Providers in Mokena, IL by specialty
• Surgical Physician Assistant in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.