Active NPI
Jill Marie Hietpas, PA C
- Physician Assistant
- Appleton, WI
National Provider Identifier
1396796660
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 1285023
- Practice address
- 1835 E Edgewood Dr Ste 10535
Appleton, WI 54913-9407 - Phone
- (920) 215-0102
- Fax
- (920) 214-0795
- NPI assigned
- May 12, 2006
- Last updated
- Oct 26, 2023
- 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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 1285023 | WI | Primary |
Addresses
Primary practice location
1835 E Edgewood Dr Ste 10535
Appleton, WI 54913-9407
Mailing address
N2611 Huss CT
Freedom, WI 54130-8674
Phone (920) 915-2669
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 32494700 | Medicaid | WI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
- Opted out of Medicare
- Yes, effective Nov 29, 2022 through Nov 29, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1285023 | WI | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Cardiovascular Surgery Associates S.C. | Past | Accepting new patients |
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.
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NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147392000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1698278400000",
"number": "1396796660",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "N2611 HUSS CT",
"city": "FREEDOM",
"state": "WI",
"postal_code": "541308674",
"telephone_number": "920-915-2669"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1835 E EDGEWOOD DR STE 10535",
"city": "APPLETON",
"state": "WI",
"postal_code": "549139407",
"telephone_number": "920-215-0102",
"fax_number": "920-214-0795"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HIETPAS",
"first_name": "JILL",
"middle_name": "MARIE",
"name_prefix": "Mrs.",
"credential": "PA C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-05-12",
"last_updated": "2023-10-26",
"certification_date": "2023-10-26",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "WI",
"license": "1285023",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "32494700",
"state": "WI"
}
],
"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 26, 2023; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.