NPIMap

Individual provider Active NPI

Matthew Krueger Jenson, MD

  • Family Medicine Physician
  • Green Bay, WI
National Provider Identifier
1063917243
Registry record updated Aug 10, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
72686 Issued in WI
Practice address
124 Siegler St
Green Bay, WI 54303-2636
Phone
(920) 494-9661
Fax
(920) 496-3792
NPI assigned
Mar 28, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 10, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 72686 WI Primary

Addresses

Primary practice location

124 Siegler St
Green Bay, WI 54303-2636

Mailing address

124 Siegler St
Green Bay, WI 54303-2636
Phone (920) 494-9661

Other practice location 1

1121 E North Ave
Milwaukee, WI 53212-3515
Phone (414) 267-6502

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210819001265 WI Practitioner - Family Practice 3577986728 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Medical College of Wisconsin, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Dousman Clinic, S.C.Group PAC ID 6507876323, 2 clinicians

Practice addresses (Care Compare)

124 Siegler St
Green Bay, WI 54303-2636
Phone 9204949661194

Hospital & facility affiliations

  • Amedisys Hospice of Green Bay Hospice, Bellevue, WI, CCN 521575
  • Amedisys Hospice of Milwaukee Hospice, Brookfield, WI, CCN 521556
  • Moments Hospice of Appleton Hospice, Appleton, WI, CCN 521606
  • Thedacare at Home Hospice, Appleton, WI, CCN 521504
  • St Marys Hospital Medical Ctr Hospital, Green Bay, WI, CCN 520097
  • St Vincent Hospital Hospital, Green Bay, WI, CCN 520075
  • Meadowbrook at Appleton Nursing home, Appleton, WI, CCN 525264
  • Evergreen Health Center Nursing home, Oshkosh, WI, CCN 525647

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10
Removal of skin lesions14
Removal of nail tissue1-10
Removal or shaving of skin growth1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Dousman Clinic, S.C. Family Medicine CurrentSince Aug 9, 2021 Accepting new patients

Locations

124 Siegler St
Green Bay, WI 54303
Phone (920) 494-9661

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Meadowbrook at AppletonAppleton, WI, CCN 525264 Skilled nursing facility Adp of the SNF Mar 1, 2022

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 1

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 12

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": "1522195200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1628553600000",
    "number": "1063917243",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "124 SIEGLER ST",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543032636",
            "telephone_number": "920-494-9661",
            "fax_number": "920-496-3792"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "124 SIEGLER ST",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543032636",
            "telephone_number": "920-494-9661",
            "fax_number": "920-496-3792"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1121 E North Ave",
            "address_purpose": "LOCATION",
            "city": "Milwaukee",
            "state": "WI",
            "postal_code": "532123515",
            "country_code": "US",
            "telephone_number": "414-267-6502",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JENSON",
        "first_name": "MATTHEW",
        "middle_name": "KRUEGER",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-03-28",
        "last_updated": "2021-08-10",
        "certification_date": "2021-08-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "72686",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Green Bay, WI

Sources for this page

Verify at the official NPI Registry.