Individual provider Active NPI

Jodi A.B. Punke, DO

  • Internal Medicine Physician
  • Sun Prairie, WI
National Provider Identifier
1225148471
Registry record updated Nov 13, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
43375-21 Issued in WI
Practice address
10 Tower Dr
Sun Prairie, WI 53590-1239
Phone
(608) 825-3500
Fax
(608) 825-3786
NPI assigned
Aug 30, 2006
Last updated
Nov 13, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 13, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 43375-21 WI Primary

Addresses

Primary practice location

10 Tower Dr
Sun Prairie, WI 53590-1239

Mailing address

10 Tower Dr
Sun Prairie, WI 53590-1239
Phone (608) 825-3500

Other practice location 1

10 Tower Dr
Sun Prairie, WI 53590
Phone (608) 825-3500

Other identifiers 1

IdentifierTypeStateIssuer
1225148471MedicaidWI

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address jpunke339772@direct-ehr-ssmhc.com Direct
FHIR URL https://fhir.ssmhc.com/fhir/api/FHIR/DSTU2/ Other

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230209000412 TX Practitioner - Family Practice 0547363848 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
43375-21WIMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Santa Ana Health Center CurrentSince Dec 5, 2022 Accepting new patients
Albuquerque Indian Health Center CurrentSince Dec 5, 2022 Accepting new patients
Santa Ana Health Clinic Pharmacy Past Accepting new patients

Locations

801 Vassar Dr NE
Albuquerque, NM 87106
Phone (505) 248-4000

2 Dove Rd
#C
Bernalillo, NM 87004
Phone (505) 867-2497

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1605225600000",
    "number": "1225148471",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 TOWER DR",
            "city": "SUN PRAIRIE",
            "state": "WI",
            "postal_code": "535901239",
            "telephone_number": "608-825-3500",
            "fax_number": "608-825-3786"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 TOWER DR",
            "city": "SUN PRAIRIE",
            "state": "WI",
            "postal_code": "535901239",
            "telephone_number": "608-825-3500",
            "fax_number": "608-825-3786"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10 Tower Dr",
            "address_purpose": "LOCATION",
            "city": "Sun Prairie",
            "state": "WI",
            "postal_code": "53590",
            "country_code": "US",
            "telephone_number": "608-825-3500",
            "fax_number": "608-825-3786",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PUNKE",
        "first_name": "JODI",
        "middle_name": "A.B.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-30",
        "last_updated": "2020-11-13",
        "certification_date": "2020-11-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WI",
            "license": "43375-21",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1225148471",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jpunke339772@direct-ehr-ssmhc.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "jpunke339772@direct-ehr-ssmhc.com",
            "address_1": "10 Tower Dr",
            "city": "Sun Prairie",
            "state": "WI",
            "country_code": "US",
            "postal_code": "535901239",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://fhir.ssmhc.com/fhir/api/FHIR/DSTU2/",
            "affiliation": "N",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "FHIR API",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCD",
            "address_1": "10 Tower Dr",
            "city": "Sun Prairie",
            "state": "WI",
            "country_code": "US",
            "postal_code": "535901239",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Sun Prairie, WI

Sources for this page

Verify at the official NPI Registry.