JACLYN L MIS (PAC) – Physician Assistant, NPI 1073899548
Physician Assistant
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Profile Insights
NPPES metrics only — not quality of care.
5,035 PHYSICIAN ASSISTANT in IL
Provider Addresses for JACLYN L MIS (PAC)
2320 High St
Blue Island, IL 604062426
Phone: (708) 388-5500
Fax: (708) 388-5672
Type: Location
17495 LA GRANGE RD
TINLEY PARK, IL 604877581
Phone: (815) 416-6641
Type: Location
2320 HIGH ST
BLUE ISLAND, IL 604062426
Phone: (708) 388-5500
Fax: (708) 388-5672
Type: Mailing
PO BOX 713260
CHICAGO, IL 606771260
Phone: (630) 469-9200
Fax: (708) 388-5672
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2011-12-12
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20111212000370 | I | Physician Assistant | IL | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 99212 | Established patient office or other outpatient visit, 10-19 minutes | 51 | 42 | $0 |
| 99232 | Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes | 50 | 38 | $0 |
| 99222 | Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes | 35 | 35 | $0 |
| 99231 | Subsequent hospital care with straightforward or low level of medical decision making, per day, if using time, at least 25 minutes | 33 | 26 | $0 |
| 49650 | Repair of groin hernia using an endoscope | 22 | 22 | $0 |
Insurance plans in this area (ZIP 60406)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| E N D O C R I N O L O G Y | IL | |
| Physician Assistant | IL | |
| Internal Medicine | IL | |
| Nurse Practitioner | IL | |
| - | IL | |
| - | IL | |
| - | IL | |
| - | IL | |
| - | IL | |
| Physical Therapist In Private Practice | IL |
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