NPIMap

Individual provider Active NPI

Jared William Kiernicki, PA-C

  • Physician Assistant
  • Green Bay, WI
National Provider Identifier
1376883397
Registry record updated Jun 2, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
5235-23 Issued in WI
Practice address
1970 S Ridge Rd
Green Bay, WI 54304-4125
Phone
(920) 430-4888
Fax
(920) 430-4889
NPI assigned
Feb 28, 2013
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 2, 2021

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA2286 KY
Physician Assistant 363A00000X 10002329A IN
Physician Assistant 363A00000X 5235-23 WI Primary

Addresses

Primary practice location

1970 S Ridge Rd
Green Bay, WI 54304-4125

Mailing address

PO Box 22487
Green Bay, WI 54305-2487
Phone (920) 445-7222

Other practice location 1

10455 Orthopaedic Dr
Newburgh, IN 47630-7955
Phone (812) 424-9291

Other practice location 2

5828 Pearl Dr
Evansville, IN 47712-8116
Phone (812) 424-9291

Other practice location 3

4011 Gateway Blvd Ste 100
Newburgh, IN 47630-8947
Phone (812) 424-9291

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
I20201002002537 WI Practitioner - Physician Assistant 1456626613 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Bellin Memorial Hospital Inc 685 clinicians
Oconto Hospital and Medical Center Inc 217 clinicians

Practice addresses (Care Compare)

1970 S Ridge Rd
Green Bay, WI 54304-4125
Phone (920) 430-4888

2020 S Webster Ave
Accounting
Green Bay, WI 54301-3505

2820 Roosevelt Rd
Marinette, WI 54143-3834
Phone (715) 735-5225

744 S Webster Ave
Green Bay, WI 54301-3505

820 Arbutus Ave
Oconto, WI 54153-2004
Phone (920) 835-1100

Hospital & facility affiliations

  • Bellin Memorial Hospital Hospital, Green Bay, WI, CCN 520049

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Oconto Hospital & Medical Center Inc CurrentSince Aug 17, 2020 Accepting new patients
Bellin Memorial Hospital Inc CurrentSince Aug 17, 2020 Accepting new patients
Oconto Hospital & Medical Center Inc CurrentSince Aug 17, 2020 Accepting new patients
Bellin Memorial Hospital Inc CurrentSince Aug 17, 2020 Accepting new patients
Oconto Hospital & Medical Center Inc Past Accepting new patients
Bellin Memorial Hospital Inc Past Accepting new patients

Locations

744 S Webster Ave
Green Bay, WI 54301
Phone (920) 433-6025

744 S Webster Ave
Fl 7
Green Bay, WI 54301

2820 Roosevelt Rd
Marinette, WI 54143
Phone (715) 330-6171

820 Arbutus Ave
Oconto, WI 54153
Phone (920) 835-1100

Interoperability endpoints

  • Direct secure messaging: jkiernicki925537@direct.emplifyhealth.org

Organizations & group practices 24

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.

View all 24

Hospital & facility affiliations 1

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": "1362009600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1622592000000",
    "number": "1376883397",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 22487",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543052487",
            "telephone_number": "920-445-7222",
            "fax_number": "920-445-2789"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1970 S RIDGE RD",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543044125",
            "telephone_number": "920-430-4888",
            "fax_number": "920-430-4889"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10455 Orthopaedic Dr",
            "address_purpose": "LOCATION",
            "city": "Newburgh",
            "state": "IN",
            "postal_code": "476307955",
            "country_code": "US",
            "telephone_number": "812-424-9291",
            "fax_number": "812-421-2722",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5828 Pearl Dr",
            "address_purpose": "LOCATION",
            "city": "Evansville",
            "state": "IN",
            "postal_code": "477128116",
            "country_code": "US",
            "telephone_number": "812-424-9291",
            "fax_number": "812-421-2722",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4011 Gateway Blvd Ste 100",
            "address_purpose": "LOCATION",
            "city": "Newburgh",
            "state": "IN",
            "postal_code": "476308947",
            "country_code": "US",
            "telephone_number": "812-424-9291",
            "fax_number": "812-421-2722",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KIERNICKI",
        "first_name": "JARED",
        "middle_name": "WILLIAM",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-02-28",
        "last_updated": "2021-06-02",
        "certification_date": "2021-06-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "KY",
            "license": "PA2286",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IN",
            "license": "10002329A",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WI",
            "license": "5235-23",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Green Bay, WI

Sources for this page

Verify at the official NPI Registry.