JEAVE RESERVA (NPI# 1669731618) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1669731618 |
| Entity Type | Individual |
| Full Name | JEAVE RESERVA |
| Credential | M.D. |
| Practice Address |
900 N 1st St Springfield IL 62702-3749 |
| Mailing Address |
1025 S 6th St Springfield IL 62703-2403 |
| Practice Telephone | 2175287541 |
| Mailing Telephone | 2175287541 |
| Enumeration Date | 2012-05-11 |
| Last Update Date | 2020-07-28 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207N00000X | Dermatology | 036153066 | IL | Allopathic & Osteopathic Physicians |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 321 N La Grange Rd, La Grange Park, IL 605265622 | 8885847888 | |
| 2160 S 1st Ave, Maywood, IL 601533328 | 7082166533 |
| Street Address |
900 N 1ST ST |
| City | SPRINGFIELD |
| State | IL |
| Zip Code | 62702-3749 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114920139 | Mary Beth Ditman | Nurse Practitioner | 900 N 1st St, Springfield, IL 62702-3749 | 2005-05-23 |
| 1013536804 | Amy N Mann | Nurse Practitioner | 900 N 1st St, Springfield, IL 62702-3749 | 2020-04-11 |
| 1295217727 | Michelle Lee Mccoy | Registered Nurse | 900 N 1st St, Springfield, IL 62702-3749 | 2018-08-31 |
| 1538640941 | Samantha E. Dunkirk | Nurse Practitioner | 900 N 1st St, Springfield, IL 62702-3749 | 2018-08-23 |
| 1376037168 | Stephanie M. Ritter | Registered Nurse | 900 N 1st St, Springfield, IL 62702-3749 | 2018-06-15 |
| 1396237376 | Jennifer L. Johnson | Registered Nurse | 900 N 1st St, Springfield, IL 62702-3749 | 2018-06-05 |
| 1265800163 | Josiah Hamilton | Physician Assistant | 900 N 1st St, Springfield, IL 62702-3749 | 2015-09-09 |
| 1700268216 | Lyndsey Heise | Internal Medicine | 900 N 1st St, Springfield, IL 62702-3749 | 2015-06-19 |
| 1689081861 | Todd Diebold | Obstetrics & Gynecology | 900 N 1st St, Springfield, IL 62702-3749 | 2014-07-19 |
| 1629418454 | Kara Lynn Mccoy | Obstetrics & Gynecology | 900 N 1st St, Springfield, IL 62702-3749 | 2013-06-25 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457866519 | Mohammad Jamal Uddin Ansari | Internal Medicine | 751 N Rutledge St Ste 400, Springfield, IL 62702 | 2017-12-11 |
| 1588105811 | Mickey Graphia | Surgery | 701 N 1st St # D346, Springfield, IL 62702 | 2017-03-20 |
| 1376908913 | Abdul Hannan | Internal Medicine | 315 W Carpenter St # B, Springfield, IL 62702 | 2015-12-28 |
| 1871986414 | Rachel Hoselton | Nurse Practitioner | 400 N 9th St Fl 4, Springfield, IL 62702 | 2015-03-06 |
| 1548697774 | Alyssa Wilson | Behavioral Analyst | 232 Bruns Lane, One Sparcenter Plaza, Springfield, IL 62702 | 2013-10-02 |
| 1174965446 | Amy Wilson | Speech-Language Pathologist | 2120 West Washington Street, Springfield, IL 62702 | 2013-07-26 |
| 1275898116 | Pele Boutrous Dina | Pediatrics | 415 N 9th St # 4w16, Springfield, IL 62702 | 2012-07-06 |
| 1427327733 | Brook D Croke | Genetic Counselor, MS | 400 N. 9th Street, 3rd Floor Clinic B, Springfield, IL 62702 | 2011-12-16 |
| 1629352604 | Renae M Sanchez | Pharmacist | 3216 East Clearlake Ave, Springfield, IL 62702 | 2011-10-07 |
| 1982915302 | William Leland Zelkovich | Radiology | 701 N 1st, Springfield, IL 62702 | 2010-06-30 |
| Find all providers in zip 62702 | ||||
| Taxonomy Code | 207N00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Dermatology |
| A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source] Additional Resources: American Board of Dermatology, 2007. http://www.abderm.org/ Board certification is provided by the American Board of Dermatology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669090445 | Peter T Demos Md | Dermatology | 125 Liberty St Ste 206, Springfield, MA 01103-1109 | 2020-07-08 |
| 1952674798 | Ernest Lorenc | Dermatology | 2053 S Pin Oak Drive, Springfield, MO 65809-3142 | 2012-02-09 |
| 1437302452 | Dermatology Clinic of Springfield | Dermatology | 1605 G Street, Springfield, OR 97477-4227 | 2008-11-04 |
| 1750585741 | Nicole Marie Cassler | Dermatology | Oregon Medical Group Dermatology, 1007 Harlow Rd., Springfield, OR 97477-7124 | 2007-06-13 |
| 1942386677 | Larry Michael Newell | Dermatology | 2951 Montvale Dr, Suite B, Springfield, IL 62704-5341 | 2006-10-27 |
| 1063517746 | Adarsh A Kumar | Dermatology | 2040 Timberbrooke Drive, Springfield, IL 62702 | 2006-09-14 |
| 1558385989 | Siu Physicians & Surgeons, Inc | Dermatology | 201 E Madison St Ste 300, Springfield, IL 62702-5131 | 2006-07-27 |
| 1114961067 | Catherine L Laughlin | Dermatology | 1536 E Primrose St, Springfield, MO 65804-7928 | 2006-06-15 |
| 1891763868 | W Gerald Klingler | Dermatology | 355 W Carpenter Street Ste A, Springfield, IL 62702 | 2006-03-08 |
| 1801866231 | Jenifer Dawn Insley | Dermatology | 3808 S Greystone Ct, Springfield, MO 65804-6561 | 2006-01-26 |
| Find all providers in SPRINGFIELD | ||||
| City | SPRINGFIELD |
| Zip Code | 62702 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.