Jean S. Bae, M.D.
Individual provider Active NPI Psychiatry Physician · Madison, WI
NPI 1093870073 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1093870073
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatry Physician 2084P0800X
- License
- 40078-020 (WI)
- Practice address
- 700 Ray O Vac Dr
Suite 220
Madison, WI 53711-2479 - Phone
- (608) 276-9191
- Fax
- (608) 276-9144
- NPI assigned
- Dec 27, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Psychiatry
- Education
- Other, 1997
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Family Therapy Center of Madison, Inc.
Practice addresses (Care Compare)
700 Ray O Vac Dr
Suite 220
Madison, WI 53711-2476
Phone (608) 276-9191
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20101203001151 | WI | Practitioner - Psychiatry | 8022902097 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 40078-020 | WI | MD | Psychiatry Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Family Therapy Center of Madison, Inc. | Psychiatry | Current |
Accepting new patients |
| Peter C. Jackson, PSYD Consulting, SC | Current |
Accepting new patients |
Locations
700 Ray O Vac Dr
Ste 220
Madison, WI 53711
Phone (608) 276-9191
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 40078-020 | WI | Yes |
Addresses
Primary practice location
700 Ray O Vac Dr
Suite 220
Madison, WI 53711-2479
Mailing address
700 Ray O Vac Dr
Suite 220
Madison, WI 53711-2479
Phone (608) 276-9191
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 34136400 | Medicaid | WI |
Other providers in Madison, WI
- Shanna R Badje
- Mary Beth Badke
- Jessica Badour
- Sukhwinder Kaur Badwal
- John Stephen Badylak
- Elizabeth Baehnk
- Eric Baer
- Geoffrey S. Baer
- Carol L Baeseman
- Annie Baeten
All providers in Madison, WI · Psychiatry Physician in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. 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.