NPIMap

Individual provider Active NPI

Jacob Becker

  • Emergency Medicine Physician
  • Monroe, WI
National Provider Identifier
1245895325
Registry record updated Feb 14, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
81002 Issued in WI
Practice address
515 22ND Ave
Monroe, WI 53566-1569
Phone
(262) 210-3633
NPI assigned
May 5, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 14, 2024

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 81002 WI
Hospitalist Physician 208M00000X 81002 WI
Student in an Organized Health Care Education/Training Program 390200000X
Emergency Medicine Physician 207P00000X 81002 WI Primary

Addresses

Primary practice location

515 22ND Ave
Monroe, WI 53566-1569

Mailing address

515 22ND Ave
Monroe, WI 53566-1569
Phone (262) 210-3633

Other practice location 1

122 S River St
Waterford, WI 53185-4152
Phone (262) 210-3633

Electronic endpoints 2

TypeEndpointUseAffiliation
FHIR URL https://webproxyprd.monroeclinic.org/FHIR-PRD/api/FHIR/DSTU2/ Other
Direct Messaging Address jbecker407812@direct-ehr-ssmhc.com Direct

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
I20220826001430 WI Practitioner - Emergency Medicine 6709114523 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Lake Erie College of Osteopathic Medicine, Erie, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
The Monroe Clinic, Inc.Group PAC ID 3072425495, 199 clinicians

Practice addresses (Care Compare)

515 22ND Ave
Monroe, WI 53566-1569
Phone (608) 324-2000

Hospital & facility affiliations

  • The Monroe Clinic Hospital, Monroe, WI, CCN 520028

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
81002WIMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
St Luke'S Methodist Hospital Current Accepting new patients
Grant Regional Health Center, Inc Family Medicine CurrentSince Jun 1, 2024 Accepting new patients
Memorial Hospital of Boscobel CurrentSince Jun 19, 2023 Accepting new patients
Memorial Hospital of Boscobel CurrentSince Jun 19, 2023 Accepting new patients
The Monroe Clinic, Inc. CurrentSince Aug 12, 2022 Accepting new patients
Grant Regional Health Center, Inc. Current Accepting new patients
The Monroe Clinic, Inc. CurrentSince Aug 12, 2022 Accepting new patients

Locations

205 Parker St
Boscobel, WI 53805
Phone (608) 375-4112

507 S Monroe St
Lancaster, WI 53813
Phone (608) 723-2131

2009 5th St
Monroe, WI 53566
Phone (608) 324-1454

100 W 8th St
Monroe, WI 53566
Phone (608) 324-1940

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

Interoperability endpoints

  • Direct secure messaging: jbecker407812@direct-ehr-ssmhc.com
  • Direct secure messaging: jbecker801275@direct.gundersenhealth.org
  • Direct secure messaging: jbecker801275@direct.emplifyhealth.org
  • Direct secure messaging: jbecker1072914@direct.unitypoint.org

Organizations & group practices 12

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 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": "1557014400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1707868800000",
    "number": "1245895325",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "515 22ND AVE",
            "city": "MONROE",
            "state": "WI",
            "postal_code": "535661569",
            "telephone_number": "262-210-3633"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "515 22ND AVE",
            "city": "MONROE",
            "state": "WI",
            "postal_code": "535661569",
            "telephone_number": "262-210-3633"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "122 S River St",
            "address_purpose": "LOCATION",
            "city": "Waterford",
            "state": "WI",
            "postal_code": "531854152",
            "country_code": "US",
            "telephone_number": "262-210-3633",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BECKER",
        "first_name": "JACOB",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-05-05",
        "last_updated": "2024-02-14",
        "certification_date": "2024-02-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "81002",
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "WI",
            "license": "81002",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "WI",
            "license": "81002",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://webproxyprd.monroeclinic.org/FHIR-PRD/api/FHIR/DSTU2/",
            "affiliation": "N",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "FHIR API",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCD",
            "address_1": "515 22nd Ave",
            "city": "Monroe",
            "state": "WI",
            "country_code": "US",
            "postal_code": "535661569",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jbecker407812@direct-ehr-ssmhc.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "jbecker407812@direct-ehr-ssmhc.com",
            "address_1": "515 22nd Ave",
            "city": "Monroe",
            "state": "WI",
            "country_code": "US",
            "postal_code": "535661569",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Monroe, WI

Sources for this page

Verify at the official NPI Registry.