Individual provider Active NPI

Jennifer Jury McIntosh, D.O.

  • Maternal & Fetal Medicine Physician
  • Milwaukee, WI
National Provider Identifier
1578732897
Registry record updated Dec 21, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Maternal & Fetal Medicine PhysicianTaxonomy code 207VM0101X
License
63633 Issued in WI
Practice address
9200 W Wisconsin Ave
Dept of Obstetrics and Gynecology
Milwaukee, WI 53226-3522
Phone
(414) 805-6624
Fax
(414) 805-6622
NPI assigned
Feb 21, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 21, 2020

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X 63633 WI
Maternal & Fetal Medicine Physician 207VM0101X 5018 OK
Maternal & Fetal Medicine Physician 207VM0101X 63633 WI Primary
Obstetrics & Gynecology Physician 207V00000X 11013849A IN

Addresses

Primary practice location

9200 W Wisconsin Ave
Dept of Obstetrics and Gynecology
Milwaukee, WI 53226-3522

Mailing address

9200 W Wisconsin Ave
Dept of Obstetrics and Gynecology
Milwaukee, WI 53226-3522
Phone (414) 805-6624

Other identifiers 1

IdentifierTypeStateIssuer
1578732897MedicaidWI

Other names 1

  • Dr. Jennifer Lyn Jury Former name

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address jmcintosh347589@direct-ehr-ssmhc.com Direct AGNESIAN HEALTHCARE INC
FHIR URL https://fhir.ssmhc.com/fhir/api/FHIR/DSTU2/ Other AGNESIAN HEALTHCARE INC

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20150421001866 WI Practitioner - Obstetrics/Gynecology 4486729662 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Obstetrics/Gynecology
Education
Michigan State University College of Osteopathic Medicine, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
The Medical College of Wisconsin IncGroup PAC ID 2668384371, 2,092 clinicians

Practice addresses (Care Compare)

17280 W N Ave
Suite 200
Brookfield, WI 53045-4366
Phone (262) 754-8000

8701 W Watertown Plank
Milwaukee, WI 53226-3548
Phone (414) 805-3666

8701 Watertown Plank Rd
Room 4041 MFRC
Milwaukee, WI 53226-3548
Phone (414) 805-3666

Hospital & facility affiliations

  • Froedtert Memorial Lutheran Hospital Hospital, Milwaukee, WI, CCN 520177

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
5018OKMDProfessional Counselor
11013849AINMDObstetrics & Gynecology Physician
63633WIMDObstetrics & Gynecology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Froedtert &the Medical College of Wisconsin Community Physicians, Inc. CurrentSince Mar 15, 2016 Accepting new patients
The Medical College of Wisconsin, Inc. CurrentSince Apr 6, 2015 Accepting new patients
Froedtert &the Medical College of Wisconsin Community Physicians, Inc. CurrentSince Mar 15, 2016 Accepting new patients
The Medical College of Wisconsin Inc Past Accepting new patients

Locations

1905 N Calhoun Rd
Brookfield, WI 53005
Phone (262) 333-0040

17280 W North Ave
Ste 200
Brookfield, WI 53045
Phone (262) 240-9640

430 E Division St
Fond du Lac, WI 54935
Phone (920) 926-4200

420 E Division St
Fond du Lac, WI 54935
Phone (920) 923-7400

W168N11237 Western Ave
Germantown, WI 53022
Phone (262) 253-5060

835 S Van Buren St
Green Bay, WI 54301
Phone (888) 901-7246

W180N8000 Town Hall Rd
Menomonee Falls, WI 53051
Phone (262) 255-2500

9200 W Wisconsin Ave
Wauwatosa, WI 53226
Phone (414) 259-3000

8701 Watertown Plank Rd
Wauwatosa, WI 53226
Phone (414) 456-4100

1155 N Mayfair Rd
Wauwatosa, WI 53226
Phone (414) 955-5990

840 N 87th St
Wauwatosa, WI 53226
Phone (414) 805-5540

3200 Pleasant Valley Rd
West Bend, WI 53095
Phone (262) 334-5533

Interoperability endpoints

  • Direct secure messaging: jmcintoshmd175065@direct.froedtert.com
  • Direct secure messaging: jmcintosh347589@direct-ehr-ssmhc.com

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 and National Provider Directory roles.

Hospital & facility affiliations 1

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": "1203552000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1608508800000",
    "number": "1578732897",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9200 W WISCONSIN AVE",
            "address_2": "DEPT OF OBSTETRICS AND GYNECOLOGY",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532263522",
            "telephone_number": "414-805-6624",
            "fax_number": "414-805-6622"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9200 W WISCONSIN AVE",
            "address_2": "DEPT OF OBSTETRICS AND GYNECOLOGY",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532263522",
            "telephone_number": "414-805-6624",
            "fax_number": "414-805-6622"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCINTOSH",
        "first_name": "JENNIFER",
        "middle_name": "JURY",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-02-21",
        "last_updated": "2020-12-21",
        "certification_date": "2020-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "WI",
            "license": "63633",
            "primary": false
        },
        {
            "code": "207VM0101X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Maternal & Fetal Medicine",
            "state": "OK",
            "license": "5018",
            "primary": false
        },
        {
            "code": "207VM0101X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Maternal & Fetal Medicine",
            "state": "WI",
            "license": "63633",
            "primary": true
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "IN",
            "license": "11013849A",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1578732897",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jmcintosh347589@direct-ehr-ssmhc.com",
            "affiliation": "Y",
            "affiliationName": "AGNESIAN HEALTHCARE INC",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "jmcintosh347589@direct-ehr-ssmhc.com",
            "address_1": "420 E Division St",
            "city": "Fond Du Lac",
            "state": "WI",
            "country_code": "US",
            "postal_code": "549354560",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://fhir.ssmhc.com/fhir/api/FHIR/DSTU2/",
            "affiliation": "Y",
            "affiliationName": "AGNESIAN HEALTHCARE INC",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "FHIR API",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCD",
            "address_1": "420 E Division St",
            "city": "Fond Du Lac",
            "state": "WI",
            "country_code": "US",
            "postal_code": "549354560",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "JENNIFER",
            "last_name": "JURY",
            "middle_name": "LYN",
            "prefix": "DR.",
            "credential": "D.O.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Milwaukee, WI

Sources for this page

Verify at the official NPI Registry.