NPIMap

Individual provider Active NPI

Jay Michael Minorik, MD

  • Orthopaedic Surgery Physician
  • Appleton, WI
National Provider Identifier
1407808330
Registry record updated Dec 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
License
44327 Issued in WI
Practice address
2105 E Enterprise Ave
Appleton, WI 54913-7862
Phone
(920) 560-1000
Fax
(920) 731-6732
NPI assigned
May 17, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 19, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery Physician 207X00000X 44327 WI Primary

Addresses

Primary practice location

2105 E Enterprise Ave
Appleton, WI 54913-7862

Mailing address

2105 E Enterprise Ave
Appleton, WI 54913-7862
Phone (920) 560-1000

Other practice location 1

212 E Green Bay St Ste B
Shawano, WI 54166-2472
Phone (920) 560-1000

Other identifiers 1

IdentifierTypeStateIssuer
34194600MedicaidWI

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
I20050901000348 WI Practitioner - Orthopedic SurgeryPractitioner - Sports MedicinePractitioner - Physical Medicine and Rehabilitation 6507898350 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Orthopedic SurgeryAlso: Sports Medicine
Education
University of Wisconsin School of Medicine, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Orthopedic and Sports Institute of the Fox Valley S CGroup PAC ID 8628089331, 13 clinicians

Practice addresses (Care Compare)

212 E Green Bay St
Suite B
Shawano, WI 54166-2472
Phone (920) 560-1000

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Knee replacement1-10
Lower limb (leg) arthroscopy (minimally invasive joint repair)1-10
Upper limb (arm) arthroscopy (minimally invasive joint repair)1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Orthopedic and Sports Institute of the Fox Valley S C Orthopaedic Surgery CurrentSince May 1, 2021 Accepting new patients
Andrews Sports Medicine and Orthopaedic Center Past Accepting new patients
Alabama Sports Medicine and Ortho Center Orthopaedic Surgery Past Accepting new patients

Locations

2105 E Enterprise Ave
Ste 113
Appleton, WI 54913
Phone (920) 560-1083

2105 E Enterprise Ave
Appleton, WI 54913
Phone (920) 560-1000

2105 E Enterprise Ave
#112
Appleton, WI 54913
Phone (920) 731-3111

2105 E Enterprise Ave
Ste 111
Appleton, WI 54913
Phone (920) 560-1000

2105 E Enterprise Ave
Ste 101
Appleton, WI 54913
Phone (920) 560-1047

212 E Green Bay St
Shawano, WI 54166
Phone (715) 526-5221

212 E Green Bay St
Ste B
Shawano, WI 54166
Phone (920) 560-1000

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/EBJABD

Organizations & group practices 3

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.

Hospital & facility affiliations 9

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": "1147824000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1734566400000",
    "number": "1407808330",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2105 E ENTERPRISE AVE",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549137862",
            "telephone_number": "920-560-1000",
            "fax_number": "920-731-6732"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2105 E ENTERPRISE AVE",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549137862",
            "telephone_number": "920-560-1000",
            "fax_number": "920-731-6732"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "212 E Green Bay St Ste B",
            "address_purpose": "LOCATION",
            "city": "Shawano",
            "state": "WI",
            "postal_code": "541662472",
            "country_code": "US",
            "telephone_number": "920-560-1000",
            "fax_number": "920-731-6732",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MINORIK",
        "first_name": "JAY",
        "middle_name": "MICHAEL",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-17",
        "last_updated": "2024-12-19",
        "certification_date": "2024-12-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "WI",
            "license": "44327",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "34194600",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Appleton, WI

Sources for this page

Verify at the official NPI Registry.