Individual provider Active NPI

Jacklyn Susan Abel, AGACNP-BC

  • Nurse Practitioner
  • Mauston, WI
National Provider Identifier
1104631506
Registry record updated Aug 5, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
16067-33 Issued in WI
Practice address
1050 Division St
Mauston, WI 53948-1931
Phone
(608) 847-6161
NPI assigned
Feb 11, 2025
Last updated
Aug 5, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 5, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 16067-33 WI Primary
Acute Care Nurse Practitioner 363LA2100X 16067-33 WI

Addresses

Primary practice location

1050 Division St
Mauston, WI 53948-1931

Mailing address

5522 E Overlook Cir
West Bend, WI 53095-8700
Phone (262) 483-4014

Other names 1

  • Jacklyn Backhaus Former name

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250402000028 WI Practitioner - Nurse Practitioner 1456874262 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mile Bluff Medical Center IncGroup PAC ID 8527971399, 87 clinicians

Practice addresses (Care Compare)

1050 Division St
Mauston, WI 53948-1931
Phone (608) 847-6161

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Mile Bluff Medical Center Inc CurrentSince Apr 1, 2025 Accepting new patients
Mile Bluff Medical Center Inc CurrentSince Apr 1, 2025 Accepting new patients
Mile Bluff Medical Center Inc Current Accepting new patients
Mile Bluff Medical Center Inc Past Accepting new patients

Locations

1040 Division St
Mauston, WI 53948
Phone (608) 847-5000

1050 Division St
Mauston, WI 53948
Phone (608) 847-6161

28 Commerce St
Wisconsin Dells, WI 53965
Phone (608) 254-5888

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

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": "1739232000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1785888000000",
    "number": "1104631506",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5522 E OVERLOOK CIR",
            "city": "WEST BEND",
            "state": "WI",
            "postal_code": "530958700",
            "telephone_number": "262-483-4014"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1050 DIVISION ST",
            "city": "MAUSTON",
            "state": "WI",
            "postal_code": "539481931",
            "telephone_number": "608-847-6161"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ABEL",
        "first_name": "JACKLYN",
        "middle_name": "SUSAN",
        "name_prefix": "Mrs.",
        "credential": "AGACNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-02-11",
        "last_updated": "2026-08-05",
        "certification_date": "2026-08-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "WI",
            "license": "16067-33",
            "primary": true
        },
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "WI",
            "license": "16067-33",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JACKLYN",
            "last_name": "BACKHAUS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Mauston, WI

Sources for this page

Verify at the official NPI Registry.