Jillian Marie Bruch

Primary specialty

DentistTaxonomy code 122300000X

License

019030183 Issued in IL

Practice address

24 Ginger Creek Pkwy
Glen Carbon, IL 62034-3502

Phone

(618) 692-1110

NPI assigned

Jun 21, 2015

Last updated

Jun 21, 2015By the provider in NPPES

Sex

Female

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 MO

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1434844800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1434844800000",
    "number": "1952783490",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24 GINGER CREEK PKWY",
            "city": "GLEN CARBON",
            "state": "IL",
            "postal_code": "620343502",
            "telephone_number": "618-692-1110"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24 GINGER CREEK PKWY",
            "city": "GLEN CARBON",
            "state": "IL",
            "postal_code": "620343502",
            "telephone_number": "618-692-1110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRUCH",
        "first_name": "JILLIAN",
        "middle_name": "MARIE",
        "name_prefix": "Dr.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-06-21",
        "last_updated": "2015-06-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IL",
            "license": "019030183",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Todd M Brammeier, D.M.D.
• Rebecca Allison Brand, LCPC
• Briana L. Oller, D.M.D., P.C. (Simply Smiles)
• Rachel Ohannah Britton, RBT
• Kennedi Brown
• Brueggeman Chiropractic Center, LLC
• Emily Ann Brueggeman, DC
• Melissa S Bruhn
• Keith Andrew Bryant, D.M.D.
• Brianna Buckle

• Dentist in Glen Carbon, IL
• Providers in Glen Carbon, IL by specialty
• Dentist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2015; 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.