NPIMap

Individual provider Active NPI

Jacob Edward Taber, DO

  • Family Medicine Physician
  • Fort Atkinson, WI
National Provider Identifier
1235711573
Registry record updated Aug 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
81240-21 Issued in WI
Practice address
740 Reena Ave
Fort Atkinson, WI 53538-3145
Phone
(920) 563-0888
Fax
(920) 568-3516
NPI assigned
Apr 26, 2021
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 13, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 81240-21 WI Primary

Addresses

Primary practice location

740 Reena Ave
Fort Atkinson, WI 53538-3145

Mailing address

740 Reena Ave
Fort Atkinson, WI 53538-3145
Phone (920) 563-0888

Other identifiers 1

IdentifierTypeStateIssuer
1235711573MedicaidWI

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL Kingsport

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240827000079 WI Practitioner - Family Practice 4587065149 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Ohio University, College of Osteopathic Medicine, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Dean Health Systems IncGroup PAC ID 7012827983, 1,174 clinicians

Practice addresses (Care Compare)

740 Reena Ave
Fort Atkinson, WI 53538-3145
Phone (920) 563-0888

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal of nail tissue1-10
Removal or shaving of skin growth1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
81240-21WIMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Dean Health Systems, Inc. CurrentSince Aug 19, 2024 Accepting new patients
Dean Health Systems, Inc Family Medicine CurrentSince Aug 19, 2024 Accepting new patients
Medical Education Assistance Corporation Family Medicine CurrentSince May 1, 2021 Accepting new patients
Medical Education Assistance Corporation Family Medicine PastSince May 1, 2021 Accepting new patients

Locations

102 E Ravine Rd
Kingsport, TN 37660
Phone (423) 245-9600

740 Reena Ave
Fort Atkinson, WI 53538
Phone (920) 563-0888

1808 W Beltline Hwy
Madison, WI 53713
Phone (608) 250-1497

515 22nd Ave
Monroe, WI 53566
Phone (608) 324-1000

Interoperability endpoints

  • Direct secure messaging: jtaber518486@direct-ehr-ssmhc.com

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 and National Provider Directory roles.

Hospital & facility affiliations 9

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": "1619395200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1723507200000",
    "number": "1235711573",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "740 REENA AVE",
            "city": "FORT ATKINSON",
            "state": "WI",
            "postal_code": "535383145",
            "telephone_number": "920-563-0888",
            "fax_number": "920-568-3516"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "740 REENA AVE",
            "city": "FORT ATKINSON",
            "state": "WI",
            "postal_code": "535383145",
            "telephone_number": "920-563-0888",
            "fax_number": "920-568-3516"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TABER",
        "first_name": "JACOB",
        "middle_name": "EDWARD",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-04-26",
        "last_updated": "2024-08-13",
        "certification_date": "2024-08-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "81240-21",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1235711573",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Kingsport",
            "affiliation": "N",
            "address_1": "102 E Ravine Rd",
            "city": "Kingsport",
            "state": "TN",
            "country_code": "US",
            "postal_code": "376603814",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Fort Atkinson, WI

Sources for this page

Verify at the official NPI Registry.