NPIMap

Individual provider Active NPI

Jennifer Lea Baumgart, APNP

  • Nurse Practitioner
  • Kaukauna, WI
National Provider Identifier
1386978260
Registry record updated Jun 6, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
3891-033 Issued in WI
Practice address
305 E 12TH St
Kaukauna, WI 54130
Phone
(920) 766-4656
Fax
(920) 766-4659
NPI assigned
Sep 25, 2009
Last updated
Jun 6, 2018By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 6, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 3891-033 WI Primary

Addresses

Primary practice location

305 E 12TH St
Kaukauna, WI 54130

Mailing address

305 E 12TH St
Kaukauna, WI 54130-2865
Phone (920) 766-4656

Other names 1

  • Jennifer Lea Degroot Former name

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
I20091117000690 WI Practitioner - Nurse Practitioner 2062550726 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Kaukauna Clinic, S.C.Group PAC ID 5597765891, 8 clinicians

Practice addresses (Care Compare)

305 E 12TH St
Kaukauna, WI 54130-2865
Phone (920) 766-4656

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
3891-033WIMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Kaukauna Clinic, S.C. CurrentSince Dec 1, 2009 Accepting new patients

Locations

305 E 12th St
Kaukauna, WI 54130
Phone (920) 766-4656

Interoperability endpoints

  • Direct secure messaging: jbaumgart11171@direct.thedacare.org

Organizations & group practices 1

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.

Hospital & facility affiliations 14

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

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1253836800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1528243200000",
    "number": "1386978260",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "305 E 12TH ST",
            "city": "KAUKAUNA",
            "state": "WI",
            "postal_code": "541302865",
            "telephone_number": "920-766-4656",
            "fax_number": "920-766-4659"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "305 E 12TH ST",
            "city": "KAUKAUNA",
            "state": "WI",
            "postal_code": "54130",
            "telephone_number": "920-766-4656",
            "fax_number": "920-766-4659"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BAUMGART",
        "first_name": "JENNIFER",
        "middle_name": "LEA",
        "credential": "APNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-09-25",
        "last_updated": "2018-06-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "WI",
            "license": "3891-033",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JENNIFER",
            "last_name": "DEGROOT",
            "middle_name": "LEA",
            "credential": "APNP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Kaukauna, WI

Sources for this page

Verify at the official NPI Registry.