Jacquelyn Rene Forssberg, APRN

Primary specialty

Women's Health Nurse PractitionerTaxonomy code 363LW0102X

License

53-76350-092 Issued in KS

Practice address

1021 Eisenhower Ave
Great Bend, KS 67530

Phone

(620) 792-5437

NPI assigned

Jul 31, 2014

Last updated

Jul 13, 2026By 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

Electronic endpoints 2

Medicare fee-for-service enrollment

Enrolled in KS

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, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Pratt Regional Medical Center CorporationGroup PAC ID 1355253238, 37 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Pratt Regional Medical Center Hospital, Pratt, KS, CCN 170027
• Hospital District #6 Patterson Health Center Hospital, Anthony, KS, CCN 171346

Merit-based Incentive Payment System (MIPS)

Final score

89.83 of 100Reported as group

Quality

82.73

Promoting interoperability

100

Improvement activities

40

Cost

83.38

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jacquelyn.forssberg.1@14930.direct.athenahealth.com
• Direct secure messaging: jacquelyn.forssberg.4@14930.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.

• Pratt Regional Medical Center Corporation

  dba Pratt Regional Medical Center

  • Rural Acute Care Hospital
  • Pratt, KS
  • NPI 1578596904
  Medicare reassignment Care Compare group NPD
• Pratt Regional Medical Center Corporation

  dba PRMC Infusion and Wound Care Clinic

  • Infusion Therapy Clinic/Center
  • Pratt, KS
  • NPI 1689246753
  NPD
• Pratt Regional Medical Center Corporation

  dba Pratt Internal Medicine Group

  • Rural Health Clinic/Center
  • Pratt, KS
  • NPI 1881025393
  NPD

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

• Hospital District No 6 of Harper County Kansas

  dba Patterson Health Center

  • Critical Access Hospital
  • Anthony, KS
  • NPI 1467427674
  Care Compare affiliation
• Hospital District No 6 of Harper County Kansas

  • Critical Access Hospital
  • Harper, KS
  • NPI 1740709955
  Care Compare affiliation
• Pratt Regional Medical Center Corporation

  dba Pratt Regional Medical Center

  • Rural Acute Care Hospital
  • Pratt, KS
  • NPI 1578596904
  Care Compare affiliation

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

{
    "created_epoch": "1406764800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1043628233",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 COMMODORE ST",
            "city": "PRATT",
            "state": "KS",
            "postal_code": "671242903",
            "telephone_number": "620-450-1186"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1021 EISENHOWER AVE",
            "city": "GREAT BEND",
            "state": "KS",
            "postal_code": "67530",
            "telephone_number": "620-792-5437"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "200 Commodore St",
            "address_purpose": "LOCATION",
            "city": "Pratt",
            "state": "KS",
            "postal_code": "671242903",
            "country_code": "US",
            "telephone_number": "620-450-1186",
            "fax_number": "620-450-1741",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FORSSBERG",
        "first_name": "JACQUELYN",
        "middle_name": "RENE",
        "name_prefix": "Mrs.",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-07-31",
        "last_updated": "2026-07-13",
        "certification_date": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LW0102X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Women's Health",
            "state": "KS",
            "license": "53-76350-092",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jacquelyn.forssberg.1@14930.direct.athenahealth.com",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "200 Commodore St",
            "city": "Pratt",
            "state": "KS",
            "country_code": "US",
            "postal_code": "671242903",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jacquelyn.forssberg.1@14930.direct.athenahealth.com",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "420 Country Club Rd",
            "city": "Pratt",
            "state": "KS",
            "country_code": "US",
            "postal_code": "671243125",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Royal Domingo Flagg
• Leonard T Fleske, MD
• FMS Midwest Dialysis Centers, LLC (Renal Care Group Great Bend)
• Kevin Ford
• Ladessa Lynn Forrest, OTR/L
• Joe D Foust, RPA
• Alexander Funkhouser, M.D.
• G Michael Allison DDS PA
• Christopher Michael Gahagan, LMLP
• Kasie Gant, APRN, FNP-C

• Women's Health Nurse Practitioner in Great Bend, KS
• Providers in Great Bend, KS by specialty
• Women's Health Nurse Practitioner in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; 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.