Jeannine Marie Fortin, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

46699 Issued in WI

Practice address

1100 Orchard Dr
Seymour, WI 54165-1600

Phone

(920) 833-5100

Fax

(920) 833-5100

NPI assigned

Jul 9, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Dr. Jeannine Marie Fortin Passey Former name

Medicare fee-for-service enrollment

Enrolled in WI, TX2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

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.

• Cleanslate Medical Group of Wisconsin, SC

  • Addiction Medicine (Internal Medicine) Physician
  • Glendale, WI
  • NPI 1518404854
  Medicare reassignment NPD
• Dhew Ind HLTH SV HLTH SVS & MNTL HLTH Adm

  dba Phoenix Indian Medical Center

  • Public Health or Welfare Agency
  • Phoenix, AZ
  • NPI 1083643738

  TX

  Medicare reassignment NPD
• Vohra Wound Physicians of the Mid-West, S.C.

  • Family Medicine Physician
  • Miramar, FL
  • NPI 1720536477

  WI

  Medicare reassignment NPD
• Dhew Ind HLTH SV HLTH SVS & MNTL HLTH Adm

  dba Ak-Chin Clinic

  • Public Health or Welfare Agency
  • Maricopa, AZ
  • NPI 1538043443
  NPD
• Aurora Medical Group, Inc.

  • Durable Medical Equipment & Medical Supplies
  • Seymour, WI
  • NPI 1235333212
  NPD (past)
• Prevea Clinic, Inc.

  • Internal Medicine Physician
  • Green Bay, WI
  • NPI 1306869276

  Family Medicine

  NPD (past)
• Prevea Regional Services, Inc.

  dba Prevea Regional

  • Family Medicine Physician
  • Green Bay, WI
  • NPI 1194748061
  NPD (past)

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

{
    "created_epoch": "1152403200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1347321600000",
    "number": "1174556450",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1100 ORCHARD DR",
            "city": "SEYMOUR",
            "state": "WI",
            "postal_code": "541651600",
            "telephone_number": "920-833-5100",
            "fax_number": "920-833-5100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 ORCHARD DR",
            "city": "SEYMOUR",
            "state": "WI",
            "postal_code": "541651600",
            "telephone_number": "920-833-5100",
            "fax_number": "920-833-5100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FORTIN",
        "first_name": "JEANNINE",
        "middle_name": "MARIE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-09",
        "last_updated": "2012-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "46699",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "34533800",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JEANNINE",
            "last_name": "FORTIN PASSEY",
            "middle_name": "MARIE",
            "prefix": "DR.",
            "credential": "M.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Lucy Deleeuw
• Kristen Diermeier, CCC-SLP
• Elizabeth Dwyer, PT
• Denise M Ellis, LAT
• Dawn Marie Forcey, PTA
• General Dentistry of Seymour Inc
• Heidi Louisa Gillis, PTA
• Good Shepherd Home, LTD (Good Shepherd Rehabilitation Agency)
• Good Shepherd Home, LTD
• Malina Herber, APNP

• Family Medicine Physician in Seymour, WI
• Providers in Seymour, WI by specialty
• Family Medicine Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.