Individual ProviderJeffrey SkinnerEmergency MedicineAllopathic & Osteopathic PhysiciansPractice Address4201 W Medical Center Dr, Mchenry, IL 60050(815) 759-4546(815) 334-5000PECOS EnrollmentBased on the most recent information from CMS, provider Jeffrey Skinner is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records yesterday at 10:51 AM.Profile DetailsProvider ID1578503991Provider TypeIndividualFull NameSkinner, JeffreyCredentialMDGenderMaleSole ProprietorNoEnumeration Date6/7/2006Last Updated6/7/2018Contact InformationPractice LocationPractice Address4201 W Medical Center Dr, Mchenry, IL 60050Phone(815) 759-4546Fax(815) 759-4110Mailing LocationMailing Address4201 W Medical Center Dr, Mchenry, IL 60050-8409Phone(815) 334-5000FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode207P00000XPrimaryDescriptionEmergency MedicineAllopathic & Osteopathic PhysiciansLicense036064948IllinoisProvider IdentifiersIDDescriptionIssuerID036064948DescriptionOtherIssuerSTATE LICENSEIllinoisID01620446DescriptionOtherIssuerBLUE CROSSIllinoisID0360649481DescriptionMedicaidIssuerUnlistedIllinoisID930106082DescriptionOtherIssuerRAILROAD MCR