JESSICA WHELAN LLC — NPI 1417570920 (Licensed & Credentialed Suppliers — Pharmacy, Compounding Pharmacy in DUPO, IL)

CMS-1500 Box 24J / 33a • NPI

1417570920

Type 2 Organization (Box 32a/33a)

HIPAA NUCC Taxonomy • CMS Code

3336C0004X (CMS 58)

Licensed & Credentialed Suppliers — Pharmacy, Compounding Pharmacy

Box 32 Service Location & ZIP+4

301 S MAIN ST, DUPO, IL, 62239-1325

✓ 9-Digit EDI 837 ZIP+4 (62239-1325)

Practice Phone & Referral Fax

(314) 470-1220

Fax: (833) 914-0432

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1417570920 (JESSICA WHELAN LLC) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

Institutional Type-2 NPI facilities enroll via CMS-855A institutional provider agreements rather than individual Order & Referring PECOS.

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1417570920` (NPI-2 Organization / Facility)
Provider / Legal Name	JESSICA WHELAN LLC
Plain-English Specialty	Licensed & Credentialed Suppliers — Pharmacy, Compounding Pharmacy NUCC Code: `3336C0004X` (Pharmacy, Compounding Pharmacy)
Certifying / Licensing Body	State Medical / Healthcare Licensing Board & National Specialty Board
Practice Location Address	301 S MAIN ST, DUPO, IL, 62239-1325
Practice Telephone / Fax	Tel: (314) 470-1220 \| Fax: (833) 914-0432
Administrative Mailing Address	16549 CLAYTON RD, WILDWOOD, MO, 63011-1720
Enumeration & Last Sync	Enumerated: 2020-05-19 \| CMS Record Updated: 2021-09-01
Authorized Official	JESSICA WHELAN (CEO)

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

301 S MAIN ST, DUPO, IL, 62239-1325

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Plain-English Taxonomy & CMS Crosswalk (3336C0004X)

What Does Taxonomy Code 3336C0004X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 3336C0004X translates to:
"Licensed & Credentialed Suppliers — Pharmacy, Compounding Pharmacy"

CMS-1500 Medicare Specialty Crosswalk: CMS Code 58 (Medical Supply Company with Pharmacist) • CMS Code A5 (Pharmacy)
Certifying / Accrediting Authority: State Medical / Healthcare Licensing Board & National Specialty Board
Clinical Scope: Consult a verified Pharmacy, Compounding Pharmacy for specialized diagnostic evaluation, treatment planning, and continuity of care.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (JESSICA WHELAN LLC)

Typical CPT / Diagnostic Procedures:

Comprehensive Outpatient & Inpatient Clinical Evaluation (CPT 99202–99215)
Diagnostic Workup, Laboratory Ordering & Evidence-Based Care Coordination
Preventive Screening, Patient Counseling & Multidisciplinary Referral

Common Therapeutic Classes:

Evidence-Based Specialty Pharmacotherapy & Preventive Regimens (CMS Part D Standard)

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`163W00000X` — Registered Nurse Plain English: Licensed & Credentialed Registered Nurse	State: N/A \| License: `Verified` \| Primary: Secondary
`2084P0800X` — Psychiatry & Neurology, Psychiatry Plain English: Board-Certified Psychiatrist (Mental Health & Behavioral Medicine Physician)	State: N/A \| License: `Verified` \| Primary: Secondary
`251J00000X` — Nursing Care Plain English: Licensed Skilled Nursing & Inpatient Post-Acute Rehabilitation Facility (SNF)	State: N/A \| License: `Verified` \| Primary: Secondary
`251S00000X` — Community/Behavioral Health Plain English: Licensed & Credentialed Community/Behavioral Health	State: N/A \| License: `Verified` \| Primary: Secondary
`261QI0500X` — Clinic/Center, Infusion Therapy Plain English: Licensed Outpatient Medical Clinic / Urgent Care & Ambulatory Center	State: N/A \| License: `Verified` \| Primary: Secondary
`261QP2300X` — Clinic/Center, Primary Care Plain English: Licensed Outpatient Medical Clinic / Urgent Care & Ambulatory Center	State: N/A \| License: `Verified` \| Primary: Secondary
`261QR1100X` — Clinic/Center, Research Plain English: Licensed Outpatient Medical Clinic / Urgent Care & Ambulatory Center	State: N/A \| License: `Verified` \| Primary: Secondary
`261QR1300X` — Clinic/Center, Rural Health Plain English: Licensed Outpatient Medical Clinic / Urgent Care & Ambulatory Center	State: N/A \| License: `Verified` \| Primary: Secondary
`3336S0011X` — Pharmacy, Specialty Pharmacy Plain English: Licensed & Credentialed Suppliers — Pharmacy, Specialty Pharmacy	State: N/A \| License: `Verified` \| Primary: Secondary
`261QM1300X` — Clinic/Center, Multi-Specialty Plain English: Licensed Outpatient Medical Clinic / Urgent Care & Ambulatory Center	State: N/A \| License: `Verified` \| Primary: Secondary
`261QM2500X` — Clinic/Center, Medical Specialty Plain English: Licensed Outpatient Medical Clinic / Urgent Care & Ambulatory Center	State: N/A \| License: `Verified` \| Primary: Secondary
`261QM0801X` — Clinic/Center, Mental Health (Including Community Mental Health Center) Plain English: Licensed Outpatient Medical Clinic / Urgent Care & Ambulatory Center	State: N/A \| License: `Verified` \| Primary: Secondary
`261QM0850X` — Clinic/Center, Adult Mental Health Plain English: Licensed Outpatient Medical Clinic / Urgent Care & Ambulatory Center	State: N/A \| License: `Verified` \| Primary: Secondary
`261QM0855X` — Clinic/Center, Adolescent and Children Mental Health Plain English: Licensed Outpatient Medical Clinic / Urgent Care & Ambulatory Center	State: N/A \| License: `Verified` \| Primary: Secondary
`3336C0004X` — Pharmacy, Compounding Pharmacy Plain English: Licensed & Credentialed Suppliers — Pharmacy, Compounding Pharmacy	State: N/A \| License: `Verified` \| Primary: Yes (Primary)

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JESSICA WHELAN LLC (NPI #1417570920)