Jenny M Bausano, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

4704259562 Issued in MI

Practice address

945 9TH St
Lake Linden, MI 49945-1100

Phone

(906) 483-1030

NPI assigned

Jun 11, 2019

Last updated

Apr 14, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Portage Physician Practices IncGroup PAC ID 6103053509, 56 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Up Health System Portage Hospital, Hancock, MI, CCN 230108

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jenny.bausano.1@8233.direct.athenahealth.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Portage Physician Practices Inc

  • Internal Medicine Physician
  • Hancock, MI
  • NPI 1225461684
  Medicare reassignment Care Compare group NPD
• Portage Physician Practices Inc

  dba UP Medical Group - Portage Express Care

  • Rural Health Clinic/Center
  • Calumet, MI
  • NPI 1164106910
  NPD
• Upper Great Lakes Family Health Center

  dba Sawyer Family Health Center

  • Federally Qualified Health Center (FQHC)
  • Gwinn, MI
  • NPI 1700103777
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Portage Hospital LLC

  dba UP Health System Portage

  • General Acute Care Hospital
  • Hancock, MI
  • NPI 1245667229
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1560211200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1618358400000",
    "number": "1003475344",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 EXPLORER ST",
            "city": "GWINN",
            "state": "MI",
            "postal_code": "498412813",
            "telephone_number": "906-346-4924",
            "fax_number": "906-346-6474"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "945 9TH ST",
            "city": "LAKE LINDEN",
            "state": "MI",
            "postal_code": "499451100",
            "telephone_number": "906-483-1030"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BAUSANO",
        "first_name": "JENNY",
        "middle_name": "M",
        "name_prefix": "Mrs.",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-06-11",
        "last_updated": "2021-04-14",
        "certification_date": "2021-04-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MI",
            "license": "4704259562",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Aspirus Keweenaw (Aspirus Keweenaw Lake Linden Clinic)
• Aspirus Keweenaw Enterprise (Aspirus Keweenaw Pharmacy - Lake Linden)
• At Home Companions, Inc.
• Morgan Nicole Codere
• Camaryn Grayce Irene Crouch
• Marcella Elaine Fundum, RPH
• Bruce Robert Macdonald, D.D.S.
• Amanda Mattila

• Family Nurse Practitioner in Lake Linden, MI
• Providers in Lake Linden, MI by specialty
• Family Nurse Practitioner in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.