Jay William Gaethke, LPC, SAC, CSW

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

3912 Issued in WI

Practice address

500 Elm Grove Rd
Suite 100
Elm Grove, WI 53122-2546

Phone

(262) 782-2090

Fax

(262) 782-2092

NPI assigned

Oct 26, 2006

Last updated

May 14, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

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, 2002

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Prohealth Medical Group IncGroup PAC ID 3476465188, 475 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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.

• Prohealth Medical Group Inc.

  • Pediatrics Physician
  • Waukesha, WI
  • NPI 1356322440
  Medicare reassignment Care Compare group NPD
• Trillium Care Group LLC

  • Psychologist
  • Elm Grove, WI
  • NPI 1477629640
  NPD (past)

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

{
    "created_epoch": "1161820800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715644800000",
    "number": "1346325446",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 ELM GROVE RD",
            "address_2": "SUITE 100",
            "city": "ELM GROVE",
            "state": "WI",
            "postal_code": "531222546",
            "telephone_number": "262-782-2090",
            "fax_number": "262-782-2092"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 ELM GROVE RD",
            "address_2": "SUITE 100",
            "city": "ELM GROVE",
            "state": "WI",
            "postal_code": "531222546",
            "telephone_number": "262-782-2090",
            "fax_number": "262-782-2092"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GAETHKE",
        "first_name": "JAY",
        "middle_name": "WILLIAM",
        "name_prefix": "Mr.",
        "credential": "LPC, SAC, CSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-26",
        "last_updated": "2024-05-14",
        "certification_date": "2024-05-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "WI",
            "license": "3912",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Melissa Danielle Fockel, MSW LCSW
• Amanda Fox, LPC
• Bette L Frangesch, RN GNP APNP
• Robert Fugiel, DC
• Functional Symmetry, LLC
• Catherine Gallagher, RN
• Katharine Rae Gandy, D.C.
• Colleen Garcia
• Lynn Joy Gauger, MSSW
• Dolores Ann Gauthier, HIS

• Professional Counselor in Elm Grove, WI
• Providers in Elm Grove, WI by specialty
• Professional Counselor in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2024; 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.