NPIMap

Individual provider Active NPI

Jennifer M Marshall, PAC

  • Physician Assistant
  • Appleton, WI
National Provider Identifier
1629078217
Registry record updated Dec 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
888 Issued in WI
Practice address
2105 E Enterprise Ave
Appleton, WI 54913-7862
Phone
(920) 560-1000
Fax
(920) 731-6732
NPI assigned
Jul 26, 2005
Last updated
Dec 19, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 19, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 888 WI Primary

Addresses

Primary practice location

2105 E Enterprise Ave
Appleton, WI 54913-7862

Mailing address

1531 S Madison St
Appleton, WI 54915
Phone (920) 996-3700

Other identifiers 1

IdentifierTypeStateIssuer
42960000MedicaidWI

Other names 1

  • Jennifer M Laubenstein Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050813000048 WI Practitioner - Physician Assistant 0042240723 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Orthopedic and Sports Institute of the Fox Valley S CGroup PAC ID 8628089331, 13 clinicians

Practice addresses (Care Compare)

2105 E Enterprise Ave
Appleton, WI 54913-7862
Phone (920) 560-1000

402 Eureka St
Ripon, WI 54971-1103
Phone (920) 560-1000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Ascension Medical Group-Fox Valley Wisconsin, Inc CurrentSince Jan 30, 2006 Accepting new patients
Ascension Medical Group-Fox Valley Wisconsin, Inc CurrentSince Jan 30, 2006 Accepting new patients

Locations

1501 S Madison St
Appleton, WI 54915
Phone (920) 730-4435

1506 S Oneida St
Appleton, WI 54915
Phone (920) 730-4950

1531 S Madison St
Appleton, WI 54915
Phone (920) 730-4411

1531 S Madison St
Ste 350
Appleton, WI 54915
Phone (920) 730-4413

1818 N Meade St
Appleton, WI 54911
Phone (920) 731-4101

61 Anne St
Clintonville, WI 54929
Phone (715) 823-7500

1550 Midway Pl
Menasha, WI 54952
Phone (920) 727-8030

2700 W 9th Ave
Oshkosh, WI 54904
Phone (920) 223-0220

500 S Oakwood Rd
Oshkosh, WI 54904
Phone (920) 223-0501

Organizations & group practices 3

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.

Hospital & facility affiliations 9

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": "1122336000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1734566400000",
    "number": "1629078217",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1531 S MADISON ST",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "54915",
            "telephone_number": "920-996-3700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2105 E ENTERPRISE AVE",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549137862",
            "telephone_number": "920-560-1000",
            "fax_number": "920-731-6732"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARSHALL",
        "first_name": "JENNIFER",
        "middle_name": "M",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-07-26",
        "last_updated": "2024-12-19",
        "certification_date": "2024-12-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WI",
            "license": "888",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "42960000",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JENNIFER",
            "last_name": "LAUBENSTEIN",
            "middle_name": "M",
            "credential": "PAC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Appleton, WI

Sources for this page

Verify at the official NPI Registry.