Individual provider Active NPI

Jennifer Margaret Nelson, MD

  • Pediatrics Physician
  • Kenosha, WI
National Provider Identifier
1649397498
Registry record updated Jul 14, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
53245-20 Issued in WI
Practice address
10400 75TH St
Pediatrics
Kenosha, WI 53142-7884
Phone
(262) 948-6367
NPI assigned
Mar 26, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 14, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 53245-20 WI Primary

Addresses

Primary practice location

10400 75TH St
Pediatrics
Kenosha, WI 53142-7884

Mailing address

1184 Mark CT
Antioch, IL 60002-9401
Phone (847) 274-7530

Other identifiers 1

IdentifierTypeStateIssuer
100004139MedicaidWI

Electronic endpoints 2

TypeEndpointUseAffiliation
FHIR URL https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/
Direct Messaging Address jnelson43328@direct.myadvocateaurora.org

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
I20090929000369 WI Practitioner - Pediatric Medicine 5698867117 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
53245-20WIMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Aurora Medical Group, Inc. CurrentSince Sep 1, 2009 Accepting new patients
Aurora Medical Group, Inc. CurrentSince Sep 1, 2009 Accepting new patients
Aurora Medical Group, Inc. Past Accepting new patients

Locations

10400 75th St
Ste 110
Kenosha, WI 53142

10117 74th St
Ste 110
Kenosha, WI 53142
Phone (262) 697-1919

10400 75th St
Kenosha, WI 53142
Phone (262) 697-7000

1020 N 12th St
Milwaukee, WI 53233
Phone (414) 219-3056

12500 Aurora Dr
Pleasant Prairie, WI 53158
Phone (262) 857-5000

Interoperability endpoints

  • Direct secure messaging: jnelson43328@direct.myadvocateaurora.org

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1174867200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689292800000",
    "number": "1649397498",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1184 MARK CT",
            "city": "ANTIOCH",
            "state": "IL",
            "postal_code": "600029401",
            "telephone_number": "847-274-7530"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10400 75TH ST",
            "address_2": "PEDIATRICS",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531427884",
            "telephone_number": "262-948-6367"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NELSON",
        "first_name": "JENNIFER",
        "middle_name": "MARGARET",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-26",
        "last_updated": "2023-07-14",
        "certification_date": "2023-07-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "WI",
            "license": "53245-20",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100004139",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "10400 75th St",
            "address_2": "Pediatrics",
            "city": "Kenosha",
            "state": "WI",
            "country_code": "US",
            "postal_code": "531427884",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jnelson43328@direct.myadvocateaurora.org",
            "affiliation": "N",
            "address_1": "10400 75th St",
            "address_2": "Pediatrics",
            "city": "Kenosha",
            "state": "WI",
            "country_code": "US",
            "postal_code": "531427884",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Kenosha, WI

Sources for this page

Verify at the official NPI Registry.