Jennifer Gayle Polacek, APNP-BC
Individual provider Active NPI Nurse Practitioner · Athens, WI
NPI 1508535360 · NPPES record last updated Sep 7, 2021
Key facts
- NPI
- 1508535360
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Nurse Practitioner 363L00000X
- License
- 11270-33 (WI)
- Practice address
- 729 Pine St
Athens, WI 54411-9305 - Phone
- (715) 257-1686
- NPI assigned
- Sep 7, 2021
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 9
Hospital & facility affiliations 9
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2021
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Aspirus Medford Hospital and Clinics Inc
Practice addresses (Care Compare)
729 Pine St
Athens, WI 54411-9305
Phone (715) 257-1687
Hospital & facility affiliations
- Compassus Home Health
- Aspirus Medford Hospital & Clinics, Inc
Merit-based Incentive Payment System (MIPS)
- Final score
- 100 of 100
- Quality
- 97.16
- Promoting interoperability
- 100
- Improvement activities
- 40
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20211112001264 | WI | Practitioner - Nurse Practitioner | 0941699938 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Aspirus Medford Hospital & Clinics, Inc. | Current | Accepting new patients | |
| Aspirus Medford Hospital & Clinics, Inc. | Current |
Accepting new patients | |
| Aspirus Medford Hospital & Clinics, Inc. | Current | Accepting new patients | |
| Aspirus Medford Hospital & Clinics, Inc. | Current |
Accepting new patients |
Locations
29980 Network Pl
Chicago, IL 60673
729 Pine St
Athens, WI 54411
Phone (715) 257-1687
135 S Gibson St
Medford, WI 54451
Phone (715) 748-8100
Interoperability endpoints
- jpolacek172842@direct.aspirus.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 11270-33 | WI | Yes |
Addresses
Primary practice location
729 Pine St
Athens, WI 54411-9305
Mailing address
W1692 Fawn Ave
Rib Lake, WI 54470-9615
Phone (715) 560-0193
Other practice location 1
W1692 Fawn Ave
Rib Lake, WI 54470-9615
Phone (715) 560-0193
Other providers in Athens, WI
- Cynthia M Conway
- Steven R Conway
- Hope Clinic SC
- Vanessa Mann
- Marshfield Clinic, Inc.
- Tanya M Schaer
- Cynthia Schmidt
- School District of Athens
- Thomas William Treweek
- Darin James Weiks
All providers in Athens, WI · Nurse Practitioner in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 7, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.