JESSICA MEDINA
NPI 1104588979
Nurse Practitioner - Family in Chicago, IL

Q: What is Jessica Medina's NPI number?

The NPI number for Jessica Medina is 1104588979. It was assigned to this individual provider in the NPPES registry on October 9, 2021.

Q: What is Jessica Medina'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 Jessica Medina was last updated on May 6, 2025. NPI Profile syncs with the weekly NPPES data releases published by CMS.

Active since October 09, 2021PECOS EnrolledAccepts Medicare Assignment

779 W ADAMS ST, CHICAGO, IL 60661(312) 382-8308 Get Directions Write a Review

NPPES record last updated: May 6, 2025. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: May 6, 2025, Oct 9, 2021 (2 updates tracked since 2021).

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About Jessica Medina NPPES

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

JESSICA MEDINA (NPI 1104588979) is an individual family provider in Chicago, Illinois, licensed in Illinois (209022090) and active in the NPI registry since October 2021. She is enrolled in Medicare PECOS, maintains a secondary practice location in Chicago, and is a graduate of Other (2020).

NPPES Registry Identity

NPI1104588979

Entity TypeIndividualFemale

Primary Taxonomy363LF0000X

Provider Legal NameJESSICA MEDINA

Location Address779 W ADAMS STChicago, IL 60661-3509

Mailing Address1323 S 49th CtCicero, IL 60804-1406 · (872) 203-1703

Phone(312) 382-8308

Sole ProprietorNo

Medical School CMSOtherGraduated 2020

Enumeration DateOctober 9, 2021

Last NPPES UpdateMay 6, 20252 updates tracked since enumeration

NPPES CertifiedMay 2, 2025

✔ NPI 1104588979 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 · 209022090

779 W ADAMS ST, Chicago, IL 60661

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Secondary Practice Location 1

Location 12233 W Division StChicago, IL 60622-8151 · Phone (312) 770-2000

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Jessica Medina is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID8729509559

PECOS Enrollment IDI20250310000359

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 60661 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.

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Other Providers at the Same Location NPPES 20

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

HANNAH KERR

Nurse Practitioner (Family)