Jennifer R Gruba, PHD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

5149-057 Issued in WI

Practice address

2901 Hunters TRL
Portage, WI 53901-3403

Phone

(608) 742-5518

Fax

(608) 742-4087

NPI assigned

Dec 23, 2010

Last updated

Dec 4, 2024By 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 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WI

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Community Service Associates, SCGroup PAC ID 8426948746, 34 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

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.

• Community Service Associates, SC

  dba Pauquette Center for Psychological Services

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Portage, WI
  • NPI 1780610923
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1293062400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733270400000",
    "number": "1033413646",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "710 N. WEBB AVE",
            "city": "REEDSBURG",
            "state": "WI",
            "postal_code": "53959",
            "telephone_number": "608-524-5151",
            "fax_number": "608-524-5353"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2901 HUNTERS TRL",
            "city": "PORTAGE",
            "state": "WI",
            "postal_code": "539013403",
            "telephone_number": "608-742-5518",
            "fax_number": "608-742-4087"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2625 Military Rd",
            "address_purpose": "LOCATION",
            "city": "Cross Plains",
            "state": "WI",
            "postal_code": "535289687",
            "country_code": "US",
            "telephone_number": "608-617-6344",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GRUBA",
        "first_name": "JENNIFER",
        "middle_name": "R",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-12-23",
        "last_updated": "2024-12-04",
        "certification_date": "2024-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "WI",
            "license": "867-124",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "WI",
            "license": "5149-057",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1033413646",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Emily Griffing
• Randy Lee Griffiths, PHARM D.
• Sara L Grimes, FNP
• Erin Shawnna Grimm, MFT
• Lynn S Groeschel, MSW
• Madeleine M Hacker, OD
• Diana Lynn Haertel
• Amy S Hall, COTA
• Kristen Hansen
• Ashley Marie Cooper Hardy

• Clinical Psychologist in Portage, WI
• Providers in Portage, WI by specialty
• Clinical Psychologist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2024; 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.