Jesse Van Butler, PA-C

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

10116 Issued in MN

Practice address

901 Montgomery St
Decorah, IA 52101-2325

Phone

(563) 382-2911

Fax

(563) 387-1512

NPI assigned

Jul 28, 2006

Last updated

Mar 8, 2011By 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 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in IA

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2004

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Winneshiek Medical CenterGroup PAC ID 4688582935, 99 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Winnmed Hospital, Decorah, IA, CCN 161371

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jbutler115322@uihcdirect.org

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.

• Winneshiek Medical Center

  dba WinnMed

  • Critical Access Hospital
  • Decorah, IA
  • NPI 1619922051
  Medicare reassignment Care Compare group NPD
• Winneshiek Medical Center

  dba WinnMed Decorah Clinic

  • Multi-Specialty Clinic/Center
  • Decorah, IA
  • NPI 1992854863
  Medicare reassignment
• Winneshiek Medical Center

  dba Winneshiek Medical Center Anesthesia

  • Certified Registered Nurse Anesthetist
  • Decorah, IA
  • NPI 1023022803
  NPD
• Neurosurgical Associates, LTD.

  • Specialist
  • Minneapolis, MN
  • NPI 1558317925
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Winneshiek Medical Center

  dba WinnMed

  • Critical Access Hospital
  • Decorah, IA
  • NPI 1619922051
  Care Compare affiliation

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

{
    "created_epoch": "1154044800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1299542400000",
    "number": "1376557769",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "901 MONTGOMERY ST",
            "city": "DECORAH",
            "state": "IA",
            "postal_code": "521012325",
            "telephone_number": "563-382-2911",
            "fax_number": "563-387-1512"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "901 MONTGOMERY ST",
            "city": "DECORAH",
            "state": "IA",
            "postal_code": "521012325",
            "telephone_number": "563-382-2911",
            "fax_number": "563-387-1512"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUTLER",
        "first_name": "JESSE",
        "middle_name": "VAN",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-28",
        "last_updated": "2011-03-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "MN",
            "license": "10116",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "001606",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0446294",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "10116",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Wendy Buenzow, BA
• Mark John Buitenwerf, D.D.S.
• James Allen Bullard, M.D.
• Alyssa Bullerman, PTA
• Brenda Lee Burke, MSW., CPM
• Renee Beth Carlson
• Criag K Carson, OD
• Raelen Carstens, MA, TLMHC
• Champion Chiropractic Life Center Inc (Champion Chiropractic)
• Choice Employment Services

• Surgical Physician Assistant in Decorah, IA
• Providers in Decorah, IA by specialty
• Surgical Physician Assistant in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 2011; 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.