Jacob Allen Klaustermeier, PAC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

085002984 Issued in IL

Practice address

820 E Terra Cotta Ave
Crystal Lake, IL 60014-3649

Phone

(815) 455-4434

Fax

(815) 455-4591

NPI assigned

Jun 9, 2008

Last updated

Apr 26, 2018By the provider in NPPES

Sex

Male

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

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2007

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Suleman J. Bangash D.O.S.C.Group PAC ID 8729165006, 17 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Northwestern Medicine Central Dupage Hospital Hospital, Winfield, IL, CCN 140242

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/24526/brand/1/csg/1/fhir/r4
• Direct secure messaging: jklaustermeier@directaddress.net

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.

• Suleman J. Bangash D.O.S.C.

  • MOHS-Micrographic Surgery Physician
  • Elgin, IL
  • NPI 1841469830
  Medicare reassignment Care Compare group
• Dermatology Physicians & Surgeons, LTD

  dba Van Dam Dermatology

  • Dermatology Physician
  • Barrington, IL
  • NPI 1932271210
  NPD
• Mohs Surgery &Dermatology

  • Specialist
  • Elgin, IL
  • NPI 1356721591
  NPD (past)
• TLC Medical Group, S.C.

  dba TLC Womens Health, S.C./TLC Pediatrics, S.C.

  • Pediatrics Physician
  • St Charles, IL
  • NPI 1649334186
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Central Dupage Hospital Association

  dba Northwestern Medicine Central Dupage Hospital

  • General Acute Care Hospital
  • Winfield, IL
  • NPI 1003864810
  Care Compare affiliation
• Central Dupage Hospital Association

  dba Northwestern Medicine Central Dupage Hospital

  • Psychiatric Hospital Unit
  • Winfield, IL
  • NPI 1740230895
  Care Compare affiliation

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

{
    "created_epoch": "1212969600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1524700800000",
    "number": "1952560443",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "820 E TERRA COTTA AVE STE 125",
            "city": "CRYSTAL LAKE",
            "state": "IL",
            "postal_code": "600143650",
            "telephone_number": "815-455-4434",
            "fax_number": "815-455-7143"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "820 E TERRA COTTA AVE",
            "city": "CRYSTAL LAKE",
            "state": "IL",
            "postal_code": "600143649",
            "telephone_number": "815-455-4434",
            "fax_number": "815-455-4591"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "820 E Terra Cotta Ave",
            "address_purpose": "LOCATION",
            "city": "Crystal Lake",
            "state": "IL",
            "postal_code": "600143649",
            "country_code": "US",
            "telephone_number": "815-455-4434",
            "fax_number": "815-455-4591",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "355 Lennon Ln",
            "address_2": "Suite 255",
            "address_purpose": "LOCATION",
            "city": "Walnut Creek",
            "state": "CA",
            "postal_code": "945982475",
            "country_code": "US",
            "telephone_number": "925-932-7704",
            "fax_number": "925-932-7752",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KLAUSTERMEIER",
        "first_name": "JACOB",
        "middle_name": "ALLEN",
        "name_prefix": "Mr.",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-06-09",
        "last_updated": "2018-04-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "IL",
            "license": "085002984",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Hae Kyun Kim
• Ray S Kim, PHD
• Steve J Kim, MA, LCPC
• Rachel R Kinnas, WHNP-BC
• Katharina Klakus
• Lilliana Klay, LCSW
• Drew Ann Klinker
• Angela L Klisz, DPT
• Kelly Knapik, LSW
• Knight Therapy Services

• Dermatology Physician in Crystal Lake, IL
• Providers in Crystal Lake, IL by specialty
• Dermatology Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 26, 2018; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.