NPI Details
DR. Jerry Lee Jensen, DO is a family medicine in South Holland, IL with 42 years of experience. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. DR. Jerry Lee Jensen, DO NPI is 1558372615. The provider is registered as an individual entity type.
The NPPES NPI record indicates the provider is a male.
Education
Medical School: MIDWESTERN UNIVERSITY, CHICAGO COLLEGE OF OSTEOPATHIC MED
Graduation Year:1984
The provider's business location address is:
15525 S PARK AVE
SUITE 113
SOUTH HOLLAND, IL
ZIP 60473-308
Phone: (708) 331-5100
Fax: (708) 331-5005
The NPI 1558372615 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.
The CLIA number assigned to this NPI record is 14D0913083 - physician office with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).
The following top HCPCS codes were publicly reported for this provider under the Medicare program for the year 2016. The reported codes are based on the top codes for each available Medicare specialty, excluding evaluation and management codes.
- Established patient office or other outpatient visit, 20-29 minutes (HCPCS:99213)
- Annual alcohol misuse screening, 15 minutes (HCPCS:G0442)
- Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit (HCPCS:G0439)
- Annual depression screening, 15 minutes (HCPCS:G0444)
- Administration of influenza virus vaccine (HCPCS:G0008)
- Influenza vaccine split virus, preservative free (HCPCS:90662)
The enumeration date for this NPI number is 8/11/2006 and was last updated on 7/25/2023.
Taxonomy Codes
The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:
| No. |
Taxonomy Code |
Taxonomy Clasification |
Taxonomy Specialization |
License Number |
License State |
Primary |
| 1 | 207Q00000X | Family Medicine | | 036071680 | ILLINOIS | Yes |
Other Identifiers
The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.
| No. |
Other Provider Identifier |
Other Provider Identifier Type |
Other Provider Identifier State |
Other Provider Identifier Issuer |
| 1 | 0031603768 | OTHER | ILLINOIS | BLUE CROSS |
| 2 | 036071680 | MEDICAID | ILLINOIS | |
| 3 | 14D0913083 | OTHER | | CLIA NUMBER |
