JENNA PEDERSON - NPI 1063966158 - Nurse Practitioner in Oak Park, IL

Q: What is Jenna Pederson's NPI number?

The NPI number for Jenna Pederson is 1063966158. It was assigned to this individual provider in the NPPES registry on August 7, 2016.

Q: What is Jenna Pederson's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.

Q: When was this NPI record last updated?

The NPPES record for Jenna Pederson was last updated on January 2, 2020. NPI Profile syncs with the weekly NPPES data releases published by CMS.

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About Jenna Pederson NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

JENNA PEDERSON (NPI 1063966158) is an individual family provider in Oak Park, Illinois, licensed in Illinois (209.014598) and active in the NPI registry since August 2016. She is enrolled in Medicare PECOS, maintains a secondary practice location in Oak Park, and is a graduate of Rush Medical College Of Rush University (2011).

NPPES Registry Identity

NPI1063966158

Entity TypeIndividualFemale

Primary Taxonomy363LF0000X

Provider Legal NameJENNA PEDERSON

Location Address3 ERIE CT STE 1300Oak Park, IL 60302-2519

Mailing Address641 W Grand Ave Apt 4Chicago, IL 60654-5534 · (612) 205-7959

Phone(708) 406-3929

Fax(708) 406-3935

Sole ProprietorNo

Medical School CMSRush Medical College Of Rush UniversityGraduated 2011

Enumeration DateAugust 7, 2016

Last NPPES UpdateJanuary 2, 2020

✔ NPI 1063966158 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363LF0000X

License✔ Licensed in IL · 209.014598

3 ERIE CT STE 1300, Oak Park, IL 60302

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Secondary Practice Location 1

Location 114 Lake StOak Park, IL 60302-2606 · Phone (708) 383-9911

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Jenna Pederson is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID4880973742

PECOS Enrollment IDI20251119000648

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 60302 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$94.06 typical visit price

range $60.08 – $183.39

Typical copayment $23.51 (range $15.02 – $45.84)

Most-billed visit code 99203

Established Patient

$105.70 typical visit price

range $18.97 – $148.12

Typical copayment $26.42 (range $4.74 – $37.03)

Most-billed visit code 99214

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 6

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MR. MISTEAD TORGBOR SAI MSW

Social Worker (Clinical)