Individual provider Active NPI

Jennifer Stengrevics, PA-C

  • Medical Physician Assistant
  • Milwaukee, WI
National Provider Identifier
1114470481
Registry record updated Mar 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
3864-23 Issued in WI
Practice address
1000 N 92ND St
Milwaukee, WI 53226-3533
Phone
(414) 266-3347
Fax
(414) 266-1616
NPI assigned
Aug 3, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 13, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 3864-23 WI Primary
Surgical Physician Assistant 363AS0400X 3864-23 WI

Addresses

Primary practice location

1000 N 92ND St
Milwaukee, WI 53226-3533

Mailing address

1000 N 92ND St
Milwaukee, WI 53226-3533
Phone (414) 266-3347

Other practice location 1

9200 W Wisconsin Ave
Milwaukee, WI 53226-3522
Phone (414) 805-6600

Other identifiers 1

IdentifierTypeStateIssuer
1114470481MedicaidWI

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
I20161115000560 WI Practitioner - Physician Assistant 2163701137 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
3864-23WIMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Children'S Specialty Group, Inc. Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: jkesslerpac203155@direct.froedtert.com
  • Direct secure messaging: jstengrevics96524@direct.chw.org

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.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1470182400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710288000000",
    "number": "1114470481",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 N 92ND ST",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532263533",
            "telephone_number": "414-266-3347",
            "fax_number": "414-266-1616"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 N 92ND ST",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532263533",
            "telephone_number": "414-266-3347",
            "fax_number": "414-266-1616"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9200 W Wisconsin Ave",
            "address_purpose": "LOCATION",
            "city": "Milwaukee",
            "state": "WI",
            "postal_code": "532263522",
            "country_code": "US",
            "telephone_number": "414-805-6600",
            "fax_number": "414-805-6622",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "STENGREVICS",
        "first_name": "JENNIFER",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-08-03",
        "last_updated": "2024-03-13",
        "certification_date": "2024-03-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "WI",
            "license": "3864-23",
            "primary": true
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "WI",
            "license": "3864-23",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1114470481",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Milwaukee, WI

Sources for this page

Verify at the official NPI Registry.