Individual provider Active NPI

Zachary Jennings, RN

  • Certified Registered Nurse Anesthetist
  • Menasha, WI
National Provider Identifier
1104607340
Registry record updated Jul 8, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
17041-33 Issued in WI
Practice address
1449 Manitowoc Rd
Menasha, WI 54952-2630
Phone
(815) 353-5824
NPI assigned
Oct 12, 2023
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 196435 WI
Certified Registered Nurse Anesthetist 367500000X 17041-33 WI Primary

Addresses

Primary practice location

1449 Manitowoc Rd
Menasha, WI 54952-2630

Mailing address

1449 Manitowoc Rd
Menasha, WI 54952-2630
Phone (815) 353-5824

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250808000683 WI Practitioner - Certified Registered Nurse Anesthetist (Crna) 6709384811 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Racine Anesthesia Services LLCGroup PAC ID 8628103777, 81 clinicians

Practice addresses (Care Compare)

1506 S Oneida St
Appleton, WI 54915-1305
Phone (920) 738-2000

Hospital & facility affiliations

  • Ascension NE Wisconsin - St Elizabeth Campus Hospital, Appleton, WI, CCN 520009

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Registered Nurse

State licenses

LicenseStateTypeSpecialty
196435WIMDRegistered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Racine Anesthesia Services, LLC Nurse Anesthetist, Certified Registered CurrentSince Jul 8, 2025 Accepting new patients
Laboratory Corportation of America Holdings Past Accepting new patients

Locations

265 Brookview Centre Way
Ste 203
Knoxville, TN 37919
Phone (865) 500-1254

1506 S Oneida St
Appleton, WI 54915
Phone (920) 730-4950

1616 N Casaloma Dr
Appleton, WI 54913
Phone (920) 268-1516

614 Memorial Dr
Chilton, WI 53014
Phone (800) 458-4042

3801 Spring St
Mount Pleasant, WI 53405
Phone (262) 636-4011

500 S Oakwood Rd
Oshkosh, WI 54904
Phone (920) 223-0501

Organizations & group practices 2

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 2

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": "1697068800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1751932800000",
    "number": "1104607340",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1449 MANITOWOC RD",
            "city": "MENASHA",
            "state": "WI",
            "postal_code": "549522630",
            "telephone_number": "815-353-5824"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1449 MANITOWOC RD",
            "city": "MENASHA",
            "state": "WI",
            "postal_code": "549522630",
            "telephone_number": "815-353-5824"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JENNINGS",
        "first_name": "ZACHARY",
        "credential": "RN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-10-12",
        "last_updated": "2025-07-08",
        "certification_date": "2025-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "WI",
            "license": "196435",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "WI",
            "license": "17041-33",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Menasha, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.