Individual provider Active NPI

Jaimee M Larson, PA-C

  • Physician Assistant
  • Green Bay, WI
National Provider Identifier
1225419120
Registry record updated Sep 22, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
3545-23 Issued in WI
Practice address
704 S Webster Ave Ste 501
Green Bay, WI 54301-3528
Phone
(920) 433-6050
Fax
(920) 433-6049
NPI assigned
Jun 16, 2015
Last updated
Sep 22, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 22, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 3545-23 WI Primary

Addresses

Primary practice location

704 S Webster Ave Ste 501
Green Bay, WI 54301-3528

Mailing address

PO Box 22487
Green Bay, WI 54305-2487
Phone (920) 445-7210

Other practice location 1

311 N 3rd Ave
Sturgeon Bay, WI 54235
Phone (920) 433-6050

Other practice location 2

2820 Roosevelt Rd
Marinette, WI 54143-3834
Phone (715) 735-5225

Other practice location 3

720 S Van Buren St
Suite 104
Green Bay, WI 54301-3534
Phone (920) 433-7471

Other identifiers 1

IdentifierTypeStateIssuer
1116573OtherNCCPA

Other names 1

  • Jaimee M Lofquist Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI, MI2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20150724011761 WI Practitioner - Physician Assistant 8628381266 Reassigns benefits to 2 organizations
I20220405001709 MI Practitioner - Physician Assistant 8628381266 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Bellin Memorial Hospital IncGroup PAC ID 8820900749, 685 clinicians

Practice addresses (Care Compare)

2020 S Webster Ave
Accounting
Green Bay, WI 54301-3505

2820 Roosevelt Rd
Marinette, WI 54143-3834
Phone (715) 735-5225

704 S Webster Ave
Green Bay, WI 54301-3528

725 S Webster Ave
Green Bay, WI 54301-3504
Phone (920) 433-3456

744 S Webster Ave
Green Bay, WI 54301-3505

820 Arbutus Ave
Oconto, WI 54153-2004
Phone (920) 835-1100

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Oconto Hospital & Medical Center Inc CurrentSince Aug 24, 2015 Accepting new patients
Bellin Memorial Hospital Inc CurrentSince Jul 27, 2015 Accepting new patients
Oconto Hospital & Medical Center Inc Past Accepting new patients
Bellin Memorial Hospital Inc Past Accepting new patients

Locations

744 S Webster Ave
Green Bay, WI 54301
Phone (920) 433-6025

2820 Roosevelt Rd
Marinette, WI 54143
Phone (715) 330-6171

820 Arbutus Ave
Oconto, WI 54153
Phone (920) 835-1100

Interoperability endpoints

  • Direct secure messaging: jlarson916529@direct.emplifyhealth.org
  • Direct secure messaging: jlofquist164639@direct.thedacare.org

Organizations & group practices 6

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 1

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": "1434412800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1695340800000",
    "number": "1225419120",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 22487",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543052487",
            "telephone_number": "920-445-7210",
            "fax_number": "920-445-7289"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "704 S WEBSTER AVE STE 501",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543013528",
            "telephone_number": "920-433-6050",
            "fax_number": "920-433-6049"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "311 N 3rd Ave",
            "address_purpose": "LOCATION",
            "city": "Sturgeon Bay",
            "state": "WI",
            "postal_code": "54235",
            "country_code": "US",
            "telephone_number": "920-433-6050",
            "fax_number": "920-743-6680",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2820 Roosevelt Rd",
            "address_purpose": "LOCATION",
            "city": "Marinette",
            "state": "WI",
            "postal_code": "541433834",
            "country_code": "US",
            "telephone_number": "715-735-5225",
            "fax_number": "715-735-5388",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "720 S Van Buren St",
            "address_2": "Suite 104",
            "address_purpose": "LOCATION",
            "city": "Green Bay",
            "state": "WI",
            "postal_code": "543013534",
            "country_code": "US",
            "telephone_number": "920-433-7471",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LARSON",
        "first_name": "JAIMEE",
        "middle_name": "M",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-06-16",
        "last_updated": "2023-09-22",
        "certification_date": "2023-09-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WI",
            "license": "3545-23",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCCPA",
            "identifier": "1116573",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JAIMEE",
            "last_name": "LOFQUIST",
            "middle_name": "M",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Green Bay, WI

Sources for this page

Verify at the official NPI Registry.