Jesse Varney Degroat Jr., M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

44111-020 Issued in WI

Practice address

1320 Wisconsin Ave
Racine, WI 53403-1978

Phone

(262) 687-5630

Fax

(262) 687-5657

NPI assigned

Mar 1, 2006

Last updated

Aug 23, 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 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Ascension Medical Group-Southeast Wisconsin Inc

  dba Ascension Medical Group

  • Internal Medicine Physician
  • Glendale, WI
  • NPI 1609881077

  Family Medicine

  NPD

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

{
    "created_epoch": "1141171200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1314057600000",
    "number": "1407823156",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "709 SHERIDAN RD",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531401137",
            "telephone_number": "262-552-9137",
            "fax_number": "262-687-5657"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1320 WISCONSIN AVE",
            "city": "RACINE",
            "state": "WI",
            "postal_code": "534031978",
            "telephone_number": "262-687-5630",
            "fax_number": "262-687-5657"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEGROAT",
        "first_name": "JESSE",
        "middle_name": "VARNEY",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-01",
        "last_updated": "2011-08-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "44111-020",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3224200",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Rieanna Dee, MS, OTR
• Tom A Defrancesco, LCSW, CADC
• David Louis Defurio, D.D.S.
• Richard L. Defurio, D.D.S.
• Joyce Shirley Degenhart, PHD
• Kaylee Deisbeck
• Carole Ann Della Pia, LCSW
• John T Dembowiak, LPT
• Gail Jean Deno
• Autumn R Depaoli, LPC-IT

• Family Medicine Physician in Racine, WI
• Providers in Racine, WI by specialty
• Family Medicine Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.