Active NPI
Jessica Leigh Pasono, D.D.S.
- General Practice Dentistry
- Green Bay, WI
National Provider Identifier
1063822328
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 7280-15
- Practice address
- 2609 Development Dr
Green Bay, WI 54311 - Phone
- (920) 499-7933
- NPI assigned
- May 7, 2014
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 7280-15 | WI | Primary |
Addresses
Primary practice location
2609 Development Dr
Green Bay, WI 54311
Mailing address
379 Clermont CT
De Pere, WI 54115-4075
Phone (952) 457-9045
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL, WI
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 2
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150603002180 | IL | Order and Referring Only - Oral Surgery | 8022339993 | |
| I20150608001995 | WI | Order and Referring Only - Oral Surgery | 8022339993 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7280-15 | WI | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1399420800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1566172800000",
"number": "1063822328",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "379 CLERMONT CT",
"city": "DE PERE",
"state": "WI",
"postal_code": "541154075",
"telephone_number": "952-457-9045"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2609 DEVELOPMENT DR",
"city": "GREEN BAY",
"state": "WI",
"postal_code": "54311",
"telephone_number": "920-499-7933"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PASONO",
"first_name": "JESSICA",
"middle_name": "LEIGH",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-05-07",
"last_updated": "2019-08-19",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "WI",
"license": "7280-15",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Green Bay, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2019; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.