NPIMap

Individual provider Active NPI

Jennifer Gayle Polacek, APNP-BC

  • Nurse Practitioner
  • Athens, WI
National Provider Identifier
1508535360
Registry record updated Sep 7, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
11270-33 Issued in WI
Practice address
729 Pine St
Athens, WI 54411-9305
Phone
(715) 257-1686
NPI assigned
Sep 7, 2021
Last updated
Sep 7, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 7, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 11270-33 WI Primary

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

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
I20211112001264 WI Practitioner - Nurse Practitioner 0941699938 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Aspirus Medford Hospital and Clinics IncGroup PAC ID 5799688602, shared by 9 NPIs, 126 clinicians

Practice addresses (Care Compare)

729 Pine St
Athens, WI 54411-9305
Phone (715) 257-1687

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Quality
97.16
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Aspirus Medford Hospital & Clinics, Inc. Current Accepting new patients
Aspirus Medford Hospital & Clinics, Inc. CurrentSince Dec 1, 2021 Accepting new patients
Aspirus Medford Hospital & Clinics, Inc. Current Accepting new patients
Aspirus Medford Hospital & Clinics, Inc. CurrentSince Dec 1, 2021 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

  • Direct secure messaging: jpolacek172842@direct.aspirus.org

Organizations & group practices 4

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.

Hospital & facility affiliations 9

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

NPI Registry JSON

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

{
    "created_epoch": "1630972800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1630972800000",
    "number": "1508535360",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "W1692 FAWN AVE",
            "city": "RIB LAKE",
            "state": "WI",
            "postal_code": "544709615",
            "telephone_number": "715-560-0193"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "729 PINE ST",
            "city": "ATHENS",
            "state": "WI",
            "postal_code": "544119305",
            "telephone_number": "715-257-1686"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "W1692 Fawn Ave",
            "address_purpose": "LOCATION",
            "city": "Rib Lake",
            "state": "WI",
            "postal_code": "544709615",
            "country_code": "US",
            "telephone_number": "715-560-0193",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "POLACEK",
        "first_name": "JENNIFER",
        "middle_name": "GAYLE",
        "credential": "APNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-09-07",
        "last_updated": "2021-09-07",
        "certification_date": "2021-09-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "WI",
            "license": "11270-33",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Athens, WI

Sources for this page

Verify at the official NPI Registry.