Individual provider Active NPI

Ross Allan Jensen, D.C.

  • Chiropractor
  • Appleton, WI
National Provider Identifier
1568690972
Registry record updated Sep 4, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
4508-012 Issued in WI
Practice address
3525 E Calumet St
Suite 600
Appleton, WI 54915-4167
Phone
(920) 733-7888
Fax
(920) 733-7881
NPI assigned
Jun 24, 2009
Last updated
Sep 4, 2012By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 4, 2012

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 4508-012 WI Primary
Chiropractor 111N00000X 2009014144 MO

Addresses

Primary practice location

3525 E Calumet St
Suite 600
Appleton, WI 54915-4167

Mailing address

3525 E Calumet St
Suite 600
Appleton, WI 54915-4167
Phone (920) 733-7888

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100331000644 WI Practitioner - Chiropractic 5395883060 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Logan College of Chiropractic, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

3525 E Calumet St
Suite 600
Appleton, WI 54915-4175
Phone (920) 733-7888

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2009014144MOMDChiropractor
4508-012WIMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Jensen Chiropractic, LLC Chiropractor CurrentSince Aug 26, 2009 Accepting new patients

Locations

11705 Gravois Rd
Sappington, MO 63127
Phone (314) 843-3039

3525 E Calumet St
Ste 600
Appleton, WI 54915
Phone (920) 733-7888

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1245801600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1346716800000",
    "number": "1568690972",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3525 E CALUMET ST",
            "address_2": "SUITE 600",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549154167",
            "telephone_number": "920-733-7888",
            "fax_number": "920-733-7881"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3525 E CALUMET ST",
            "address_2": "SUITE 600",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549154167",
            "telephone_number": "920-733-7888",
            "fax_number": "920-733-7881"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JENSEN",
        "first_name": "ROSS",
        "middle_name": "ALLAN",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-06-24",
        "last_updated": "2012-09-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "WI",
            "license": "4508-012",
            "primary": true
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MO",
            "license": "2009014144",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Appleton, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.