Jacquelyn Rene Forssberg, APRN
Individual provider Active NPI Women's Health Nurse Practitioner · Great Bend, KS
NPI 1043628233 · NPPES record last updated Jul 13, 2026
Key facts
- NPI
- 1043628233
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Women's Health Nurse Practitioner 363LW0102X
- License
- 53-76350-092 (KS)
- Practice address
- 1021 Eisenhower Ave
Great Bend, KS 67530 - Phone
- (620) 792-5437
- NPI assigned
- Jul 31, 2014
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 6
Hospital & facility affiliations 3
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2014
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Pratt Regional Medical Center Corporation
Practice addresses (Care Compare)
420 Country Club Rd
Pratt, KS 67124-3125
Phone (620) 672-7415
Hospital & facility affiliations
- Pratt Regional Medical Center
- Hospital District #6 Patterson Health Center
Merit-based Incentive Payment System (MIPS)
- Final score
- 89.83 of 100
- Quality
- 82.73
- Promoting interoperability
- 100
- Improvement activities
- 40
- Cost
- 83.38
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in KS
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160510002483 | KS | Practitioner - Nurse Practitioner | 2264721539 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 53-76350-092 | KS | MD | Pediatric Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Pratt Regional Medical Center Corporation | Current | Accepting new patients | |
| Pratt Regional Medical Center Corporation | Current |
Accepting new patients | |
| Pratt Regional Medical Center Corporation | Current |
Accepting new patients |
Locations
1206 W Frontview St
Ste 203
Dodge City, KS 67801
Phone (620) 225-7710
200 Commodore St
Pratt, KS 67124
Phone (620) 672-6476
420 Country Club Rd
Pratt, KS 67124
Phone (620) 672-7415
203 Watson St
Ste 300
Pratt, KS 67124
Phone (620) 672-1002
124 Commodore St
Ste B
Pratt, KS 67124
Phone (620) 393-5661
Interoperability endpoints
- jacquelyn.forssberg.4@14930.direct.athenahealth.com
- jacquelyn.forssberg.1@14930.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Women's Health Nurse Practitioner | 363LW0102X | 53-76350-092 | KS | Yes |
Addresses
Primary practice location
1021 Eisenhower Ave
Great Bend, KS 67530
Mailing address
200 Commodore St
Pratt, KS 67124-2903
Phone (620) 450-1186
Other practice location 1
200 Commodore St
Pratt, KS 67124-2903
Phone (620) 450-1186
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | jacquelyn.forssberg.1@14930.direct.athenahealth.com | Health Information Exchange (HIE) | |
| Direct Messaging Address | jacquelyn.forssberg.1@14930.direct.athenahealth.com | Health Information Exchange (HIE) |
Other providers in Great Bend, KS
- Royal Domingo Flagg
- Leonard T Fleske
- FMS Midwest Dialysis Centers, LLC
- Kevin Ford
- Ladessa Lynn Forrest
- Joe D Foust
- Alexander Funkhouser
- G Michael Allison DDS PA
- Christopher Michael Gahagan
- Kasie Gant
All providers in Great Bend, KS · Women's Health Nurse Practitioner in Kansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 13, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.