NPIMap

Individual provider Active NPI

Jenna Marie Rust, D.O.

  • Family Medicine Physician
  • Warren, MI
National Provider Identifier
1326440983
Registry record updated Dec 28, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
68353-21 Issued in WI
Practice address
27450 Schoenherr Rd Ste 400
Warren, MI 48088-6684
Phone
(586) 582-7550
Fax
(586) 582-7515
NPI assigned
Sep 25, 2014
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 28, 2017

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 5101021472 MI
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X 68353-21 WI Primary

Addresses

Primary practice location

27450 Schoenherr Rd Ste 400
Warren, MI 48088-6684

Mailing address

PO Box 19070
Green Bay, WI 54307-9070
Phone (920) 496-4700

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
I20180112001349 WI Practitioner - Family Practice 7618273368 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Michigan State University College of Osteopathic Medicine, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

2793 Lineville Rd
Green Bay, WI 54313-7152
Phone (920) 496-4700

Hospital & facility affiliations

  • HSHS Home Care Wisconsin Home health agency, Green Bay, WI, CCN 527132
  • Unity Hospice Hospice, De Pere, WI, CCN 521503
  • St Vincent Hospital Hospital, Green Bay, WI, CCN 520075
  • St Marys Hospital Medical Ctr Hospital, Green Bay, WI, CCN 520097

Merit-based Incentive Payment System (MIPS)

Final score
94.81 of 100Reported as apm
Quality
85.98
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
68353-21WIMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
St Nicholas Hospital-Sisters of the Third Order of St Francis Single Specialty CurrentSince Jan 8, 2018 Accepting new patients
St Clare Memorial Hospital, Inc Single Specialty CurrentSince Sep 1, 2019 Accepting new patients
St. Nicholas Hospital-Sisters of the Third Order of St Francis Single Specialty Current Accepting new patients
St. Nicholas Hospital-Sisters of the Third Order of St Francis CurrentSince Jan 8, 2018 Accepting new patients
Prevea Clinic, Inc. Family Medicine CurrentSince Jan 8, 2018 Accepting new patients
St Vincent Hospital-Hospital Sisters-Third Order of St Francis Single Specialty CurrentSince Jan 8, 2018 Accepting new patients
Prevea Clinic, Inc. Single Specialty CurrentSince Jan 8, 2018 Accepting new patients
St Vincent Hospital-Hospital Sisters-Third Order of St Francis Single Specialty CurrentSince Jan 8, 2018 Accepting new patients
St. Clare Memorial Hospital, Inc Single Specialty CurrentSince Sep 1, 2019 Accepting new patients
St Vincent Hospital-Hospital Sisters-Third Order of St Francis Single Specialty Past Accepting new patients

Locations

1726 Shawano Ave
Green Bay, WI 54303
Phone (920) 432-6016

835 S Van Buren St
Green Bay, WI 54301
Phone (888) 901-7246

2793 Lineville Rd
Howard, WI 54313

950 Woodlake Rd
Kohler, WI 53044
Phone (920) 783-3150

855 S Main St
Ste 1
Oconto Falls, WI 54154
Phone (920) 846-8187

3100 Superior Ave
Sheboygan, WI 53081
Phone (800) 472-6710

Organizations & group practices 10

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 8

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": "1411603200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1514419200000",
    "number": "1326440983",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 19070",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543079070",
            "telephone_number": "920-496-4700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "27450 SCHOENHERR RD STE 400",
            "city": "WARREN",
            "state": "MI",
            "postal_code": "480886684",
            "telephone_number": "586-582-7550",
            "fax_number": "586-582-7515"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUST",
        "first_name": "JENNA",
        "middle_name": "MARIE",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-09-25",
        "last_updated": "2017-12-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "5101021472",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "68353-21",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Warren, MI

Sources for this page

Verify at the official NPI Registry.