Jacylyn Denise Wahl, MPAS, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

4815 Issued in WI

Practice address

150 E Cook Ave Ste 100
Libertyville, IL 60048-2060

Phone

(847) 232-3342

NPI assigned

Sep 25, 2018

Last updated

Jan 27, 2021By the provider in NPPES

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

Medicare fee-for-service enrollment

Enrolled in WI, IL2 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

Medicare enrollment (NPD)

Enrolled

State licenses

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Ganesha Institute of Neurology and Psychiatry SC

  dba A Ray of Hope: The Great Lakes Institute of Neurology and Psychiatry

  • Neurology Physician
  • Libertyville, IL
  • NPI 1629478599

  WI

  Medicare reassignment
• Ganesha Institute of Neurology and Psychiatry SC

  • Neurology Physician
  • Kenosha, WI
  • NPI 1619731320

  Physician Assistant

  NPD
• Anewu LLC

  • General Practice Physician
  • Thiensville, WI
  • NPI 1457914301
  NPD (past)

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

{
    "created_epoch": "1537833600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611705600000",
    "number": "1245715309",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "150 E COOK AVE STE 100",
            "city": "LIBERTYVILLE",
            "state": "IL",
            "postal_code": "600482060",
            "telephone_number": "847-232-3342"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 E COOK AVE STE 100",
            "city": "LIBERTYVILLE",
            "state": "IL",
            "postal_code": "600482060",
            "telephone_number": "847-232-3342"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1650 Cochrane Cir",
            "address_purpose": "LOCATION",
            "city": "Fort Carson",
            "state": "CO",
            "postal_code": "809134613",
            "country_code": "US",
            "telephone_number": "719-526-7000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "12970 W Bluemound Rd Ste 200",
            "address_purpose": "LOCATION",
            "city": "Elm Grove",
            "state": "WI",
            "postal_code": "531222607",
            "country_code": "US",
            "telephone_number": "262-780-1020",
            "fax_number": "262-780-1022",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WAHL",
        "first_name": "JACYLYN",
        "middle_name": "DENISE",
        "credential": "MPAS, PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-09-25",
        "last_updated": "2021-01-27",
        "certification_date": "2021-01-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WI",
            "license": "4815",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kaitlyn Nicole Vu, DPM
• Tosha Vyas
• A Yaser Wafai, MD
• Christina Wagner, M.S., LCPC
• Jennifer Wagner, LCSW
• Waldemar Mysiak MD SC (Family Health Center)
• Walgreen Co (Walgreens #05258)
• Walgreen Co (Walgreens #05257)
• Ann Walsh
• Lisa Walsh

• Physician Assistant in Libertyville, IL
• Providers in Libertyville, IL by specialty
• Physician Assistant in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2021; 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.