Individual provider Active NPI

Jessica Chapin, PHD

  • Clinical Neuropsychologist
  • Hartland, WI
National Provider Identifier
1477747103
Registry record updated Nov 30, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical NeuropsychologistTaxonomy code 103G00000X
License
2887 Issued in WI
Practice address
600 Walnut Ridge Dr
Hartland, WI 53029-9385
Phone
(262) 369-7068
NPI assigned
Sep 6, 2007
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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Neuropsychologist 103G00000X 2887 WI Primary

Addresses

Primary practice location

600 Walnut Ridge Dr
Hartland, WI 53029-9385

Mailing address

600 Walnut Ridge Dr
Hartland, WI 53029-9385
Phone (262) 369-7068

Other practice location 1

215 Washington St
Grafton, WI 53024-1700
Phone (262) 375-3700

Other identifiers 1

IdentifierTypeStateIssuer
100015802MedicaidWI

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address jchapin14586@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: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110812000475 WI Practitioner - Clinical Psychologist 6103911417 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Aurora Medical Group, Inc.Group PAC ID 6709794258, 3,764 clinicians

Practice addresses (Care Compare)

1020 N 12TH St
Milwaukee, WI 53233-1308
Phone (414) 219-3056

600 Walnut Ridge Dr
Hartland, WI 53029-9385
Phone (262) 369-7040

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Aurora Medical Group, Inc. CurrentSince Jun 22, 2011 Accepting new patients
Aurora Medical Group, Inc. CurrentSince Jun 22, 2011 Accepting new patients
Aurora Medical Group, Inc. Past Accepting new patients

Locations

215 Washington St
Grafton, WI 53024
Phone (262) 375-3700

2305 San Luis Pl
Green Bay, WI 54304
Phone (920) 494-2817

600 Walnut Ridge Dr
Hartland, WI 53029
Phone (262) 369-6902

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

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.

NPI Registry JSON

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

{
    "created_epoch": "1189036800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638230400000",
    "number": "1477747103",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 WALNUT RIDGE DR",
            "city": "HARTLAND",
            "state": "WI",
            "postal_code": "530299385",
            "telephone_number": "262-369-7068"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 WALNUT RIDGE DR",
            "city": "HARTLAND",
            "state": "WI",
            "postal_code": "530299385",
            "telephone_number": "262-369-7068"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "215 Washington St",
            "address_purpose": "LOCATION",
            "city": "Grafton",
            "state": "WI",
            "postal_code": "530241700",
            "country_code": "US",
            "telephone_number": "262-375-3700",
            "fax_number": "262-376-6020",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CHAPIN",
        "first_name": "JESSICA",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-09-06",
        "last_updated": "2021-11-30",
        "certification_date": "2021-11-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "WI",
            "license": "2887",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100015802",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jchapin14586@direct.myadvocateaurora.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "215 Washington St",
            "city": "Grafton",
            "state": "WI",
            "country_code": "US",
            "postal_code": "530241700",
            "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": "215 Washington St",
            "city": "Grafton",
            "state": "WI",
            "country_code": "US",
            "postal_code": "530241700",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Hartland, WI

Sources for this page

Verify at the official NPI Registry.