Individual provider Active NPI

Matthew G Jager, OT

  • Occupational Therapist
  • Appleton, WI
National Provider Identifier
1366726960
Registry record updated Oct 1, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
License
4997-26 Issued in WI
Practice address
1650 Tri Park Way Ste a
Appleton, WI 54914-1698
Phone
(920) 830-6697
Fax
(920) 830-6707
NPI assigned
Oct 1, 2011
Last updated
Oct 1, 2011By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 1, 2011

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapist 225X00000X 4997-26 WI Primary
Occupational Therapist 225X00000X 002157 IA
Occupational Therapist 225X00000X 104051 MN

Addresses

Primary practice location

1650 Tri Park Way Ste a
Appleton, WI 54914-1698

Mailing address

1650 Tri Park Way Ste a
Appleton, WI 54914-1698

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
104051MNMDOccupational Therapist
4997-26WIMDOccupational Therapist
002157IAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Blankenheim Occupational Therapy Occupational Therapist Past Accepting new patients
Blankenheim Services, LLC Occupational Therapist Past Accepting new patients

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1317427200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1317427200000",
    "number": "1366726960",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1650 TRI PARK WAY STE A",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549141698"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1650 TRI PARK WAY STE A",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549141698",
            "telephone_number": "920-830-6697",
            "fax_number": "920-830-6707"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JAGER",
        "first_name": "MATTHEW",
        "middle_name": "G",
        "credential": "OT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-10-01",
        "last_updated": "2011-10-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "WI",
            "license": "4997-26",
            "primary": true
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "IA",
            "license": "002157",
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "MN",
            "license": "104051",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Appleton, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.