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Active NPI 1710222807 Individual Practitioner Female Practitioner

Cynthia Ann Jack , NP

Nurse Practitioner • Rockford, IL

Professional Overview & Biography Verified Profile Summary

Cynthia Jack, NP is a registered healthcare professional specializing in Nurse Practitioner in Rockford, IL. Practice services are available at 2300 N ROCKTON AVE under active NPI credentials.

Frequently performed procedures and clinical services include established patient outpatient office visit. Full Medicare procedure pricing transparency rates and service volume details are listed on this profile.

Practice Location & Contact Primary Location

Practice Address

2300 N Rockton Ave

Rockford, IL 611033619

Telephone 8159712000
Associated Practice Facility / Clinic

Specialty Benchmarks & Practice Insights

Comparative analytics for Nurse Practitioner in Rockford, IL

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 10.7 Yrs
State Avg: 10.4 Yrs
Regional Practice Density
130 Specialists

Practicing in Rockford, IL (4929 Statewide)

Telehealth Adoption Rate
13.8% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
52.2% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Performed Procedures & Service Volume

Top Medicare Part B procedures performed by this practitioner

CMS Official Data (2018)
Reporting Year:
HCPCS Code & Description Services Patients Submitted Charge Medicare Allowed
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more
28 21 $181.00 $85.67
99213 Established patient office or other outpatient visit, typically 15 minutes
15 11 $124.00 $59.97

Medical Specialties & State Licenses

CMS Verified: 2020-09-18
Nurse Practitioner Primary Specialty

NUCC Taxonomy Code: 363L00000X

State License IL 209.009900

(1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners.

Nurse Practitioner - Occupational Health

NUCC Taxonomy Code: 363LX0106X

State License IL 209009900

Definition to come...

Additional State Medicaid & Healthcare Payer Identifiers

Medicaid State Provider ID
1710222807 (WI)
Commercial Insurance / Payer ID State Of Illinois License
209.009900 (IL)

Secondary Practice Locations

2000 Lake Ave

Woodstock, IL 600987401

Phone: 8153377100

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

40 Associated Practitioners
Dr. Prasad Kilaru , MD

Internal Medicine - Cardiovascular Disease

NPI 1003910423

Doctor of Medicine (M.D.)

Dr. David Mitchell , MD

Internal Medicine

NPI 1013027200

Doctor of Medicine (M.D.)

Jennifer Davidson , OT

Occupational Therapist

NPI 1013479575

Occupational Therapist

NPI 1033161435

Doctor of Medicine (M.D.)

Dr. Robin Hovis , MD

Internal Medicine - Rheumatology

NPI 1033229224

Doctor of Medicine (M.D.)

Mary Mather , CNM

Advanced Practice Midwife

NPI 1033262522

Certified Nurse Midwife

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

8 Historical Events
👤
Provider Name / Credentials Updated September 18, 2020

Recorded as CYNTHIA JACK, NP

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) September 18, 2020

Nurse Practitioner (License #209009900 in IL)

NPI Profile Active November 30, 2012

NPI status registered as active in NPPES database

📍
Updated Practice Location November 30, 2012

Registered at 2300 N ROCKTON AVE, ROCKFORD, IL 611033619 (Tel: 8159712000)

📍
Updated Business Mailing Address November 30, 2012

Registered at 2300 N ROCKTON AVE, ROCKFORD, IL 611033619 (Tel: 8159712000)

👤
Provider Name / Credentials Updated November 30, 2012

Recorded as CYNTHIA JACK, ANP

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) November 30, 2012

Nurse Practitioner (License #209.009900 in IL)

🟢
Initial NPI Registration & Enumeration November 30, 2012

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1710222807
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: November 30, 2012
Last Update: September 18, 2020
Sole Proprietor: No

Mailing Address

2300 N Rockton Ave

Rockford, IL 611033619

Phone: 8159712000

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.