Individual provider Active NPI

Brynn Emily Ehlers Jaschen, DO

  • Pediatrics Physician
  • Green Bay, WI
National Provider Identifier
1649763129
Registry record updated Sep 16, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
82083-21 Issued in WI
Practice address
2793 Lineville Rd
Green Bay, WI 54313-7152
Phone
(920) 496-4700
NPI assigned
Jun 11, 2018
Last updated
Sep 16, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 16, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 82083-21 WI Primary
Pediatrics Physician 208000000X 195533 AK

Addresses

Primary practice location

2793 Lineville Rd
Green Bay, WI 54313-7152

Mailing address

PO Box 19070
Green Bay, WI 54307-9070
Phone (920) 496-4700

Other identifiers 1

IdentifierTypeStateIssuer
100429554MedicaidWI

Other names 1

  • Dr. Brynn Emily Ehlers Professional name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address behlersjaschen531140@ewd.direct.hshs.org Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA, AK2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20210618000062 GA Practitioner - Pediatric Medicine 8921408576 Reassigns benefits to 1 organization
I20220915003549 AK Practitioner - Pediatric Medicine 8921408576 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
195533AKMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Tanana Valley Clinic LLC CurrentSince Sep 19, 2022 Accepting new patients
Au Medical Associates Inc CurrentSince Jul 1, 2021 Accepting new patients
Au Medical Associates Inc CurrentSince Jul 1, 2021 Accepting new patients
Tanana Valley Clinic LLC CurrentSince Sep 19, 2022 Accepting new patients
Fairbanks Memorial Hospital, LLC Past Accepting new patients

Locations

1001 Noble St
Fairbanks, AK 99701
Phone (907) 276-2806

1650 Cowles St
Fairbanks, AK 99701
Phone (907) 452-8181

1120 15th St
Augusta, GA 30912
Phone (706) 721-3873

1120 15th St
Ste BI1056
Augusta, GA 30912
Phone (706) 721-2785

Organizations & group practices 5

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": "1528675200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1789516800000",
    "number": "1649763129",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 19070",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543079070",
            "telephone_number": "920-496-4700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2793 LINEVILLE RD",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543137152",
            "telephone_number": "920-496-4700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EHLERS JASCHEN",
        "first_name": "BRYNN",
        "middle_name": "EMILY",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-06-11",
        "last_updated": "2026-09-16",
        "certification_date": "2026-09-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "WI",
            "license": "82083-21",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "AK",
            "license": "195533",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100429554",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "behlersjaschen531140@ewd.direct.hshs.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/CCD/TXT",
            "address_1": "2793 Lineville Rd",
            "city": "Green Bay",
            "state": "WI",
            "country_code": "US",
            "postal_code": "543137152",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "BRYNN",
            "last_name": "EHLERS",
            "middle_name": "EMILY",
            "prefix": "DR.",
            "credential": "DO",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

Other providers in Green Bay, WI

Sources for this page

Verify at the official NPI Registry.