Jodi L Space, APNP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

5012-33 Issued in WI

Practice address

5416 Everybodys Rd
Crandon, WI 54520-8627

Phone

(715) 478-4890

NPI assigned

Sep 10, 2012

Last updated

Jan 19, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

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

Specialty

Nurse Practitioner

Education

University of Missouri, Columbia School of Medicine, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Forest County Potawatomi CommunityGroup PAC ID 3375454689, 21 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/8439/brand/1/csg/21/fhir/r4
• Direct secure messaging: jodi.space.1@8439.direct.athenahealth.com

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.

• Forest County Potawatomi Community

  dba Potawatomi Health & Wellness Center

  • Federally Qualified Health Center (FQHC)
  • Crandon, WI
  • NPI 1285741306
  Medicare reassignment Care Compare group
• Aspirus Medford Hospital & Clinics, Inc.

  dba Aspirus Gilman Clinic

  • Rural Health Clinic/Center
  • Gilman, WI
  • NPI 1285703173
  Medicare reassignment NPD
• Aspirus Medford Hospital & Clinics, Inc.

  dba Aspirus Medford Hospital

  • Medicare Defined Swing Bed Hospital Unit
  • Medford, WI
  • NPI 1427105923
  NPD
• Aspirus Medford Hospital & Clinics, Inc.

  dba Aspirus Phillips Clinic

  • Rural Health Clinic/Center
  • Phillips, WI
  • NPI 1891971768
  NPD
• Forest County Potawatomi Health & Wellness Center

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Crandon, WI
  • NPI 1376650499
  NPD

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

{
    "created_epoch": "1347235200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1642550400000",
    "number": "1518217280",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5416 EVERYBODYS RD",
            "city": "CRANDON",
            "state": "WI",
            "postal_code": "545208627",
            "telephone_number": "715-478-4890"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5416 EVERYBODYS RD",
            "city": "CRANDON",
            "state": "WI",
            "postal_code": "545208627",
            "telephone_number": "715-478-4890"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SPACE",
        "first_name": "JODI",
        "middle_name": "L",
        "name_prefix": "Mrs.",
        "credential": "APNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-09-10",
        "last_updated": "2022-01-19",
        "certification_date": "2022-01-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "WI",
            "license": "5012",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "WI",
            "license": "5012-33",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Courtney Schwefel, RN
• Ashley Seiler, NP
• Christopher P Skaggs, SPEECH LANGUAGE PATH
• Sokaogon Chippewa Community
• Sokaogon Chippewa Community (Sokaogon Chippewa Health Clinic)
• Shalynn Sprink
• Jennifer Lynn Stein, FNP-C
• Tina Irene Taylor
• The Center for Human Restoration, Inc
• Betty S Thunder, ADVANCED PRACTICE SO

• Psychiatric/Mental Health Nurse Practitioner in Crandon, WI
• Providers in Crandon, WI by specialty
• Psychiatric/Mental Health Nurse Practitioner in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.