NPIMap

Individual provider Active NPI

Brian Douglas Jenkins, D.O.

  • General Practice Physician
  • Neenah, WI
National Provider Identifier
1497725295
Registry record updated Mar 5, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
5101015609 Issued in MI
Practice address
1305 W American Dr
Neenah, WI 54956-1993
Phone
(800) 201-1194
Fax
(920) 720-7392
NPI assigned
Jan 24, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 5, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Physician 208D00000X 5101015609 MI Primary

Addresses

Primary practice location

1305 W American Dr
Neenah, WI 54956-1993

Mailing address

1305 W American Dr
Neenah, WI 54956-1993
Phone (800) 201-1194

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
I20110921000096 WI Practitioner - Neurology 9537330683 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Neurology
Education
At Still University of Health Sciences, College of Osteo Med, Kirksville, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
The Neuroscience Group of Northeast Wisconsin SCGroup PAC ID 6204740186, 57 clinicians

Practice addresses (Care Compare)

130 2ND St W Pavillion 2ND Floor
Neenah, WI 54956-2883
Phone (920) 725-9373

1305 W American Dr
Neenah, WI 54956-1993
Phone (920) 725-9373

1818 N Meade St
Neuroscience Group
Appleton, WI 54911-3454
Phone (920) 725-9373

445 W Calumet St
Neuroscience Group
Appleton, WI 54915-1401
Phone (920) 725-9373

Hospital & facility affiliations

  • Thedacare Regional Med Ctr - Neenah Hospital, Neenah, WI, CCN 520045
  • Thedacare Regional Medical Center - Appleton Inc Hospital, Appleton, WI, CCN 520160
  • Thedacare Medical Center-Waupaca Hospital, Waupaca, WI, CCN 521334
  • Ascension NE Wisconsin - St Elizabeth Campus Hospital, Appleton, WI, CCN 520009

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5101015609MIMDGeneral Practice Physician

Practice roles

OrganizationSpecialtyStatusNew patients
The Neuroscience Group of Northeast Wisconsin SC CurrentSince Sep 1, 2011 Accepting new patients

Locations

1818 N Meade St
Appleton, WI 54911
Phone (920) 731-4101

445 W Calumet St
Appleton, WI 54915

1305 West American Dr
Neenah, WI 54956
Phone (920) 729-7687

130 2nd St
Neenah, WI 54956
Phone (920) 729-2063

Interoperability endpoints

  • Direct secure messaging: bjenkins32936@direct.thedacare.org

Organizations & group practices 1

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 16

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1138060800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1330905600000",
    "number": "1497725295",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1305 W AMERICAN DR",
            "city": "NEENAH",
            "state": "WI",
            "postal_code": "549561993",
            "telephone_number": "800-201-1194",
            "fax_number": "920-720-7392"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1305 W AMERICAN DR",
            "city": "NEENAH",
            "state": "WI",
            "postal_code": "549561993",
            "telephone_number": "800-201-1194",
            "fax_number": "920-720-7392"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JENKINS",
        "first_name": "BRIAN",
        "middle_name": "DOUGLAS",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-24",
        "last_updated": "2012-03-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "MI",
            "license": "5101015609",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Neenah, WI

Sources for this page

Verify at the official NPI Registry.