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DR. JASON PENCEK DC, FNP
NPI 1215463393
Nurse Practitioner - Family in Clarendon Hills, IL

Active since May 10, 2017Opted out of Medicare · through Mar 1, 2027
4 WALKER AVE STE A, CLARENDON HILLS, IL 60514(630) 734-3454 Get Directions Write a Review

NPPES record last updated: May 10, 2017. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Dr. Jason Pencek Dc, Fnp NPPES

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

DR. JASON PENCEK DC, FNP (NPI 1215463393) is an individual family provider in Clarendon Hills, Illinois, licensed in Illinois (209.015396) and active in the NPI registry since May 2017. He has opted out of Medicare through March 1, 2027.

NPPES Registry Identity

NPI1215463393
Entity TypeIndividualMale
Primary Taxonomy363LF0000X
Provider Legal NameDR. JASON PENCEKCredential: DC, FNP
Location Address4 WALKER AVE STE AClarendon Hills, IL 60514-1351
Mailing Address1102 N Damen Ave, #gChicago, IL 60622-3633 · (217) 414-2162
Phone(630) 734-3454
Sole ProprietorYes
Enumeration DateMay 10, 2017
✔ NPI 1215463393 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LF0000X
License✔ Licensed in IL · 209.015396
Also ListedChiropractorTaxonomy 111N00000X · License 038.013075 (IL)
4 WALKER AVE STE A, Clarendon Hills, IL 60514
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Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

ⓘ

Opted out of Medicare

Dr. Jason Pencek Dc, Fnp has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from March 1, 2025 through March 1, 2027.

Opt-Out Effective DateMarch 1, 2025
Opt-Out In Effect ThroughMarch 1, 2027Opt-out affidavits renew automatically every two years unless cancelled

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jason Pencek's NPI number?

The NPI number for Jason Pencek is 1215463393. It was assigned to this individual provider in the NPPES registry on May 10, 2017.

Where is Jason Pencek located?

Jason Pencek practices at 4 Walker Ave Ste A, Clarendon Hills, IL 60514. The listed phone number is (630) 734-3454.

What is Jason Pencek's specialty?

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

Is Jason Pencek enrolled in Medicare?

No. Jason Pencek has opted out of Medicare through March 1, 2027. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out.

When was this NPI record last updated?

The NPPES record for Jason Pencek was last updated on May 10, 2017. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 9 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.