Jeremy Vern Woodliff, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

8752-125 Issued in WI

Practice address

230 Park St
Wautoma, WI 54982-9031

Phone

(920) 787-6550

Fax

(920) 787-0421

NPI assigned

Sep 10, 2021

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in WI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Opportunity Development Centers IncGroup PAC ID 6901263912, 2 clinicians

Practice addresses (Care Compare)

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 and National Provider Directory roles.

• Opportunity Development Centers, Inc.

  • Developmentally Disabled Services Day Training Agency
  • Wisconsin Rapids, WI
  • NPI 1013161587
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1631232000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1672790400000",
    "number": "1316616592",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1230",
            "city": "WAUTOMA",
            "state": "WI",
            "postal_code": "549821230",
            "telephone_number": "920-787-6550"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "230 PARK ST",
            "city": "WAUTOMA",
            "state": "WI",
            "postal_code": "549829031",
            "telephone_number": "920-787-6550",
            "fax_number": "920-787-0421"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WOODLIFF",
        "first_name": "JEREMY",
        "middle_name": "VERN",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-09-10",
        "last_updated": "2023-01-04",
        "certification_date": "2023-01-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "WI",
            "license": "4018-226",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "WI",
            "license": "8752-125",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michael S Wingrove, DPT
• Wisconsin Optometric Eye Doctor, Inc.
• Laurinda S Wittenhagen, LCSW
• Patti A Wohlfeil, RN
• W George Wojcik, SAC

• Professional Counselor in Wautoma, WI
• Providers in Wautoma, WI by specialty
• Professional Counselor in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2023; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.