Individual provider Active NPI

Jennifer Renee Cappelle, M.D.

  • Pediatrics Physician
  • Two Rivers, WI
National Provider Identifier
1467710202
Registry record updated Nov 30, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
61571 Issued in WI
Practice address
5300 Memorial Dr
Two Rivers, WI 54241-3923
Phone
(920) 793-7300
NPI assigned
Apr 30, 2012
Last updated
Nov 30, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 30, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 61571 WI Primary
Student in an Organized Health Care Education/Training Program 390200000X

Addresses

Primary practice location

5300 Memorial Dr
Two Rivers, WI 54241-3923

Mailing address

5300 Memorial Dr
Two Rivers, WI 54241-3923

Other identifiers 1

IdentifierTypeStateIssuer
100036314MedicaidWI

Other names 1

  • Jennifer Renee Kolb Former name

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address jcappelle149735@direct.myadvocateaurora.org Direct
FHIR URL https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150715001385 WI Practitioner - Pediatric Medicine 0749413284 Reassigns benefits to 1 organization

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Aurora Medical Group, Inc. CurrentSince Jul 31, 2015 Accepting new patients
Aurora Medical Group, Inc. CurrentSince Jul 31, 2015 Accepting new patients
Aurora Medical Group, Inc. Past Accepting new patients

Locations

1020 N 12th St
Milwaukee, WI 53233
Phone (414) 219-3056

5300 Memorial Dr
Two Rivers, WI 54241
Phone (920) 793-7300

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1335744000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638230400000",
    "number": "1467710202",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5300 MEMORIAL DR",
            "city": "TWO RIVERS",
            "state": "WI",
            "postal_code": "542413923"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5300 MEMORIAL DR",
            "city": "TWO RIVERS",
            "state": "WI",
            "postal_code": "542413923",
            "telephone_number": "920-793-7300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CAPPELLE",
        "first_name": "JENNIFER",
        "middle_name": "RENEE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-04-30",
        "last_updated": "2021-11-30",
        "certification_date": "2021-11-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "WI",
            "license": "61571",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100036314",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jcappelle149735@direct.myadvocateaurora.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "5300 Memorial Dr",
            "city": "Two Rivers",
            "state": "WI",
            "country_code": "US",
            "postal_code": "542413923",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "5300 Memorial Dr",
            "city": "Two Rivers",
            "state": "WI",
            "country_code": "US",
            "postal_code": "542413923",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "JENNIFER",
            "last_name": "KOLB",
            "middle_name": "RENEE",
            "credential": "M.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Two Rivers, WI

Sources for this page

Verify at the official NPI Registry.