Active NPI
Kerry B Jedele, MD
- Pediatrics Physician
- La Crosse, WI
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 48163
- Practice address
- 1836 South Ave
La Crosse, WI 54601-5429 - Phone
- (608) 782-7300
- NPI assigned
- Sep 13, 2005
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 48163 | WI | Primary |
Addresses
Primary practice location
1836 South Ave
La Crosse, WI 54601-5429
Mailing address
1836 South Ave
La Crosse, WI 54601-5429
Phone (608) 782-7300
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 34682300 | Medicaid | WI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WI
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Gundersen Clinic LTD | Current | Accepting new patients | |
| Gundersen Lutheran Medical Center Inc | Current | Accepting new patients | |
| Gundersen Clinic LTD | Current | Accepting new patients | |
| Gundersen Lutheran Medical Center Inc | Current | Accepting new patients | |
| Gundersen Lutheran Medical Center, Inc | Current | Accepting new patients | |
| Gundersen Lutheran Express Care, Inc | Current | Accepting new patients |
Locations
402 W Lake St
Friendship, WI 53934
Phone (608) 339-3331
1836 South Ave
La Crosse, WI 54601
Phone (608) 788-8102
1910 South Ave
La Crosse, WI 54601
Phone (608) 775-2287
1600 Main St
Onalaska, WI 54650
Phone (608) 783-4681
610 E Taylor St
Prairie du Chien, WI 53821
Phone (608) 326-6466
Interoperability endpoints
- kjedele5899@direct.gundersenhealth.org
Organizations & group practices 6
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.
-
- Clinic/Center
- La Crosse, WI
- NPI 1851343115
-
- Clinic/Center
- La Crosse, WI
- NPI 1225873458
-
- Community/Retail Pharmacy
- La Crosse, WI
- NPI 1548710627
-
- Clinic/Center
- La Crosse, WI
- NPI 1043446974
-
- General Acute Care Hospital
- La Crosse, WI
- NPI 1376593442
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Onalaska, WI
- NPI 1871837567
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1126569600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1459728000000",
"number": "1356336754",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1836 SOUTH AVE",
"city": "LA CROSSE",
"state": "WI",
"postal_code": "546015429",
"telephone_number": "608-782-7300"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1836 SOUTH AVE",
"city": "LA CROSSE",
"state": "WI",
"postal_code": "546015429",
"telephone_number": "608-782-7300"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JEDELE",
"first_name": "KERRY",
"middle_name": "B",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-09-13",
"last_updated": "2016-04-04",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "WI",
"license": "48163",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "34682300",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}
Other providers in La Crosse, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2016; 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.