Jessica Pawlicki

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

277000116 Issued in IL

Practice address

820 E Terra Cotta Ave Ste 132
Crystal Lake, IL 60014-3655

Phone

(815) 322-9300

NPI assigned

Nov 5, 2014

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

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.

Opted out of Medicare

Yes, effective Jun 24, 2020 through Jun 24, 2028

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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.

• Well-Rooted Functional Medicine

  • Medical Specialty Clinic/Center
  • Woodstock, IL
  • NPI 1205421237
  NPD Authorized official
• Well-Rooted Pediatrics LLC

  • Family Nurse Practitioner
  • Crystal Lake, IL
  • NPI 1780157602
  NPD Authorized official

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

{
    "created_epoch": "1415145600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1572480000000",
    "number": "1972909877",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "820 E TERRA COTTA AVE STE 132",
            "city": "CRYSTAL LAKE",
            "state": "IL",
            "postal_code": "600143655"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "820 E TERRA COTTA AVE STE 132",
            "city": "CRYSTAL LAKE",
            "state": "IL",
            "postal_code": "600143655",
            "telephone_number": "815-322-9300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PAWLICKI",
        "first_name": "JESSICA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-11-05",
        "last_updated": "2019-10-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IL",
            "license": "277000116",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Umesh O Patel, M.D.
• Patients First Medical Equipment of West Georgia, LLC
• Hannah Paul
• Mallory Suzanne Pavlik, LPC
• Kristine H Pavlis
• Breanna Elizabeth Payne
• Nicole Payton, PHARMD
• April Pearce
• Pearl of Crystal Lake, LLC
• Pediatric & Orthopedic Rehabilitation Associates, P.C.

• Nurse Practitioner in Crystal Lake, IL
• Providers in Crystal Lake, IL by specialty
• Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2019; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.