Individual provider Active NPI

Jacqueline Sue Wolff-Ellifson

  • Nurse Practitioner
  • Madison, WI
National Provider Identifier
1023653847
Registry record updated Mar 4, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
9603 Issued in WI
Practice address
2402 Winnebago St
Madison, WI 53704-5341
Phone
(608) 242-6840
Fax
(608) 245-6117
NPI assigned
Nov 15, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 4, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 9603-33 WI
Nurse Practitioner 363L00000X 9603 WI Primary

Addresses

Primary practice location

2402 Winnebago St
Madison, WI 53704-5341

Mailing address

7974 Uw Health CT
Middleton, WI 53562-5531

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
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

Enrollment IDStateProvider typePAC IDDetails
I20191227002028 WI Practitioner - Nurse Practitioner 4789018763 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

2402 Winnebago St
Madison, WI 53704-5341
Phone (608) 287-2770

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
9603WIMDNurse Practitioner
9603-33WIMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
St Luke'S Methodist Hospital Current Accepting new patients
University of Wisconsin Medical Foundation, Inc CurrentSince Apr 1, 2024 Accepting new patients
Fort Healthcare Inc Nurse Practitioner Current Accepting new patients
University of Wisconsin Medical Foundation, Inc CurrentSince Apr 1, 2024 Accepting new patients
Fort Healthcare Inc CurrentSince Jan 6, 2020 Accepting new patients
University of Wisconsin Medical Foundation Inc Past Accepting new patients

Locations

611 Sherman Ave E
Fort Atkinson, WI 53538
Phone (920) 563-6667

200 E Tyranena Park Rd
Lake Mills, WI 53551
Phone (920) 648-3113

600 Highland Ave
Madison, WI 53792
Phone (608) 263-0325

20 S Park St
Madison, WI 53715
Phone (608) 287-2090

2402 Winnebago St
Madison, WI 53704
Phone (608) 242-6840

7974 Uw Health Ct
Middleton, WI 53562
Phone (608) 829-5270

Interoperability endpoints

  • FHIR API: https://fhir-myrecord.cerner.com/r4/8F7ruIta-JA7ecm4ommy-Q50dF1FkFe4/
  • Direct secure messaging: jwolffellifson1061537@direct.unitypoint.org

Organizations & group practices 6

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

Hospital & facility affiliations 1

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

NPI Registry JSON

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

{
    "created_epoch": "1573776000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1709510400000",
    "number": "1023653847",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7974 UW HEALTH CT",
            "city": "MIDDLETON",
            "state": "WI",
            "postal_code": "535625531"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2402 WINNEBAGO ST",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537045341",
            "telephone_number": "608-242-6840",
            "fax_number": "608-245-6117"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WOLFF-ELLIFSON",
        "first_name": "JACQUELINE",
        "middle_name": "SUE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-11-15",
        "last_updated": "2024-03-04",
        "certification_date": "2024-03-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "WI",
            "license": "9603-33",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "WI",
            "license": "9603",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Madison, WI

Sources for this page

Verify at the official NPI Registry.