Individual provider Active NPI

Jacqueline K Dake, NP

  • Pediatric Nurse Practitioner
  • Milwaukee, WI
National Provider Identifier
1487904785
Registry record updated Sep 13, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Nurse PractitionerTaxonomy code 363LP0200X
License
82180 Issued in WI
Practice address
9000 W Wisconsin Ave
Pediatric Nephrology
Milwaukee, WI 53226-4874
Phone
(414) 337-7140
Fax
(414) 337-7145
NPI assigned
Sep 13, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 13, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Nurse Practitioner 363LP0200X 82180 WI Primary

Addresses

Primary practice location

9000 W Wisconsin Ave
Pediatric Nephrology
Milwaukee, WI 53226-4874

Mailing address

9000 W Wisconsin Ave
Pediatric Nephrology
Milwaukee, WI 53226-4874
Phone (414) 337-7140

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130314000311 WI Practitioner - Nurse Practitioner 9436394764 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
87.99 of 100Reported as group
Quality
82.81
Promoting interoperability
100
Improvement activities
40
Cost
77.15

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
82180WIMDPediatric Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
The Medical College of Wisconsin, Inc. CurrentSince Jan 14, 2013 Accepting new patients
Children'S Specialty Group, Inc. CurrentSince Jul 13, 2024 Accepting new patients

Locations

10911 N Port Washington Rd
Mequon, WI 53092
Phone (262) 241-2080

Bin 88350
Milwaukee, WI 53288
Phone (414) 805-3122

8701 Watertown Plank Rd
Wauwatosa, WI 53226
Phone (414) 456-4100

9000 W Wisconsin Ave
Wauwatosa, WI 53226
Phone (414) 266-2625

Interoperability endpoints

  • Direct secure messaging: jdake2901@direct.chw.org

Organizations & group practices 2

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": "1347494400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1347494400000",
    "number": "1487904785",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9000 W WISCONSIN AVE",
            "address_2": "PEDIATRIC NEPHROLOGY",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532264874",
            "telephone_number": "414-337-7140",
            "fax_number": "414-337-7145"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9000 W WISCONSIN AVE",
            "address_2": "PEDIATRIC NEPHROLOGY",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532264874",
            "telephone_number": "414-337-7140",
            "fax_number": "414-337-7145"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAKE",
        "first_name": "JACQUELINE",
        "middle_name": "K",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-09-13",
        "last_updated": "2012-09-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "WI",
            "license": "82180",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Milwaukee, WI

Sources for this page

Verify at the official NPI Registry.