Individual provider Active NPI

Jacalyn A Nelson, MD

  • Sleep Medicine (Internal Medicine) Physician
  • Fitchburg, WI
National Provider Identifier
1063430833
Registry record updated Oct 27, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sleep Medicine (Internal Medicine) PhysicianTaxonomy code 207RS0012X
License
49405-20 Issued in WI
Practice address
2844 Index Rd
Fitchburg, WI 53713-3117
Phone
(608) 229-7979
Fax
(608) 229-8110
NPI assigned
Jul 18, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 27, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Sleep Medicine (Internal Medicine) Physician 207RS0012X 49405-20 WI Primary
Pulmonary Disease Physician 207RP1001X 49405-020 WI

Addresses

Primary practice location

2844 Index Rd
Fitchburg, WI 53713-3117

Mailing address

2844 Index Rd
Fitchburg, WI 53713-3117
Phone (608) 229-7979

Other identifiers 1

IdentifierTypeStateIssuer
1063430833MedicaidWI

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address jnelson261035@direct-ehr-ssmhc.com Direct
FHIR URL https://fhir.ssmhc.com/fhir/api/FHIR/DSTU2/ Other

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060907000327 WI Practitioner - Sleep MedicinePractitioner - NeurologyPractitioner - Pulmonary Disease 7012911902 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Sleep MedicineAlso: Neurology
Education
University of Wisconsin School of Medicine, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Dean Health Systems IncGroup PAC ID 7012827983, 1,174 clinicians

Practice addresses (Care Compare)

2844 Index Rd
Fitchburg, WI 53713-3117
Phone (608) 229-7979

Hospital & facility affiliations

  • Stoughton Hospital Hospital, Stoughton, WI, CCN 521343
  • Grant Regional Health Center Hospital, Lancaster, WI, CCN 521322

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
49405-020WIMDPulmonary Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Dean Health Systems, Inc. CurrentSince Jul 20, 2006 Accepting new patients
Grant Regional Health Center, Inc. CurrentSince Jun 1, 2024 Accepting new patients
Grant Regional Health Center, Inc CurrentSince Jun 1, 2024 Accepting new patients
St Luke'S Methodist Hospital Current Accepting new patients
Dean Health Systems, Inc CurrentSince Jul 20, 2006 Accepting new patients

Locations

2844 Index Rd
Fitchburg, WI 53713
Phone (608) 229-7979

2844 Index Rd
Slp Ctr
Fitchburg, WI 53713
Phone (608) 229-7979

507 S Monroe St
Lancaster, WI 53813
Phone (608) 723-2131

1808 W Beltline Hwy
Madison, WI 53713
Phone (608) 250-1497

515 22nd Ave
Monroe, WI 53566
Phone (608) 324-1000

715 W Pleasant St
Portage, WI 53901
Phone (608) 745-5900

100 N Main St
Richland Ctr, WI 53581
Phone (608) 647-8995

Interoperability endpoints

  • Direct secure messaging: jnelson261035@direct-ehr-ssmhc.com
  • Direct secure messaging: jnelson1072915@direct.unitypoint.org

Organizations & group practices 5

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 4

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": "1153180800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603756800000",
    "number": "1063430833",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2844 INDEX RD",
            "city": "FITCHBURG",
            "state": "WI",
            "postal_code": "537133117",
            "telephone_number": "608-229-7979",
            "fax_number": "608-229-8110"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2844 INDEX RD",
            "city": "FITCHBURG",
            "state": "WI",
            "postal_code": "537133117",
            "telephone_number": "608-229-7979",
            "fax_number": "608-229-8110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NELSON",
        "first_name": "JACALYN",
        "middle_name": "A",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-18",
        "last_updated": "2020-10-27",
        "certification_date": "2020-10-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RS0012X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Sleep Medicine",
            "state": "WI",
            "license": "49405-20",
            "primary": true
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "WI",
            "license": "49405-020",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1063430833",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jnelson261035@direct-ehr-ssmhc.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "jnelson261035@direct-ehr-ssmhc.com",
            "address_1": "2844 Index Rd",
            "city": "Fitchburg",
            "state": "WI",
            "country_code": "US",
            "postal_code": "537133117",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://fhir.ssmhc.com/fhir/api/FHIR/DSTU2/",
            "affiliation": "N",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "FHIR API",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCD",
            "address_1": "2844 Index Rd",
            "city": "Fitchburg",
            "state": "WI",
            "country_code": "US",
            "postal_code": "537133117",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Fitchburg, WI

Sources for this page

Verify at the official NPI Registry.