Active NPI
Jacqueline A Van Manen, DO
- Family Medicine Physician
- Onalaska, WI
National Provider Identifier
1568570521
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 49529
- Practice address
- 191 Theater Road
Onalaska, WI 54650-8679 - Phone
- (608) 392-5005
- Fax
- (608) 392-5792
- NPI assigned
- Aug 29, 2006
- Last updated
- Jan 29, 2024
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 49529 | WI | Primary |
Addresses
Primary practice location
191 Theater Road
Onalaska, WI 54650-8679
Mailing address
200 1St St SW
Rochester, MN 55905-0002
Phone (608) 785-0940
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Apr 1, 2023 through Apr 1, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 49529 | WI | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156809600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1706486400000",
"number": "1568570521",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "200 1ST ST SW",
"city": "ROCHESTER",
"state": "MN",
"postal_code": "559050002",
"telephone_number": "608-785-0940"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "191 THEATER ROAD",
"city": "ONALASKA",
"state": "WI",
"postal_code": "546508679",
"telephone_number": "608-392-5005",
"fax_number": "608-392-5792"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VAN MANEN",
"first_name": "JACQUELINE",
"middle_name": "A",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-29",
"last_updated": "2024-01-29",
"certification_date": "2024-01-29",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "WI",
"license": "49529",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Onalaska, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2024; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.