Jacqueline Maria Fennerty, DPM

Primary specialty

PodiatristTaxonomy code 213E00000X

License

DP00292 Issued in OR

Practice address

1435 G St
Springfield, OR 97477-4113

Phone

(541) 735-9420

NPI assigned

Nov 27, 2006

Last updated

Jan 14, 2025By the provider in NPPES

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

Other identifiers 1

Other names 1

• Dr. Jacqueline Maria Kordich Professional name

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in OR

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

Specialty

Podiatry

Education

California School of Podiatric Medicine, 1996

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

G Street Integrated HealthGroup PAC ID 6800126145, 22 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• G Street Integrated Health

  • Clinic/Center
  • Springfield, OR
  • NPI 1730734161
  Medicare reassignment Care Compare group NPD
• Sanders Family Medicine, LLC

  • Family Medicine Physician
  • Eugene, OR
  • NPI 1447095237
  NPD
• Dr. Lacey J Loveland DPM PC

  dba Oregon Foot & Ankle Center

  • Podiatrist
  • Eugene, OR
  • NPI 1114104197
  NPD (past)
• Seeds of Change Counseling Services, LLC.

  • Mental Health Counselor
  • Eugene, OR
  • NPI 1972212611
  NPD (past)

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

{
    "created_epoch": "1164585600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736812800000",
    "number": "1992871495",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25121 TRIPP RD",
            "city": "ELMIRA",
            "state": "OR",
            "postal_code": "974379612",
            "telephone_number": "415-219-3875",
            "fax_number": "541-302-9481"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1435 G ST",
            "city": "SPRINGFIELD",
            "state": "OR",
            "postal_code": "974774113",
            "telephone_number": "541-735-9420"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "25121 Tripp Rd",
            "address_purpose": "LOCATION",
            "city": "Elmira",
            "state": "OR",
            "postal_code": "974379612",
            "country_code": "US",
            "telephone_number": "541-521-9387",
            "fax_number": "541-302-9481",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FENNERTY",
        "first_name": "JACQUELINE",
        "middle_name": "MARIA",
        "name_prefix": "Dr.",
        "credential": "DPM",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-11-27",
        "last_updated": "2025-01-14",
        "certification_date": "2025-01-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "OR",
            "license": "DP00292",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "150584",
            "state": "OR"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "thefamilyfootclinic@hotmail.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "25121 Tripp Rd",
            "city": "Elmira",
            "state": "OR",
            "country_code": "US",
            "postal_code": "974379612",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "JACQUELINE",
            "last_name": "KORDICH",
            "middle_name": "MARIA",
            "prefix": "DR.",
            "credential": "DPM",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Brittany J Farro, PA-C
• Christy Faucher
• Jodi Le Feagaimaalii, QMHA-I, CADC-R, THW
• Daryl Alvan Fedak
• Lior Feldman, MD
• Genoa Goetz Ferguson, M.D.
• Leah Fertig
• Annika Fiedler
• Brian William Fields, D.O.
• Joyce Ann Findley, MHFRA

• Podiatrist in Springfield, OR
• Providers in Springfield, OR by specialty
• Podiatrist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2025; 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.