Jennifer Michele Philbin, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

44305 Issued in WI

Practice address

200 E Tyranena Park Rd
Lake Mills, WI 53551-9678

Phone

(920) 648-8393

Fax

(920) 648-3656

NPI assigned

Jul 14, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir-myrecord.cerner.com/r4/8F7ruIta-JA7ecm4ommy-Q50dF1FkFe4/
• Direct secure messaging: jennifer.philbin@direct.forthc.com

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.

• Fort Healthcare Inc

  • Otolaryngology Physician
  • Fort Atkinson, WI
  • NPI 1417993361

  Family Medicine, WI

  Medicare reassignment NPD
• Fort Healthcare Inc

  • Rural Health Clinic/Center
  • Fort Atkinson, WI
  • NPI 1417450115

  Family Medicine

  NPD
• Prevea Clinic, Inc.

  • Internal Medicine Physician
  • Green Bay, WI
  • NPI 1306869276

  Family Medicine

  NPD (past)
• Prevea Regional Services, Inc.

  • Family Medicine Physician
  • Green Bay, WI
  • NPI 1194748061

  Family Medicine

  NPD (past)

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

{
    "created_epoch": "1152835200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1528084209",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 E TYRANENA PARK RD",
            "city": "LAKE MILLS",
            "state": "WI",
            "postal_code": "535519678",
            "telephone_number": "920-648-8393",
            "fax_number": "920-648-3656"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 E TYRANENA PARK RD",
            "city": "LAKE MILLS",
            "state": "WI",
            "postal_code": "535519678",
            "telephone_number": "920-648-8393",
            "fax_number": "920-648-3656"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHILBIN",
        "first_name": "JENNIFER",
        "middle_name": "MICHELE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-14",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "44305",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "34210300",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Alyssa Kelli Murfield, PTA
• NSH Lake Mills LLC
• Opening Doors Together, LLC
• Optimal Physical Therapy, LLC
• Oral Health Clinic Inc
• Elizabeth R Pomeroy, OTR, CLT-LANA
• Tiffany Amber Quinn, R.N.
• Laurie Ann Radke, PTA
• Veronica Rejon, MD
• Resonating Change LLC

• All providers in Lake Mills, WI
• Family Medicine Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.