NPIMap

Individual provider Active NPI

Jake Degroot, RN, MSN, FNP

  • Nurse Practitioner
  • Appleton, WI
National Provider Identifier
1669229720
Registry record updated May 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
15326-33 Issued in WI
Practice address
1818 N Meade St
Appleton, WI 54911-3454
Phone
(920) 731-8900
NPI assigned
May 6, 2024
Last updated
May 6, 2024By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 6, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 15326-33 WI Primary

Addresses

Primary practice location

1818 N Meade St
Appleton, WI 54911-3454

Mailing address

5680 N Amethyst Dr
Appleton, WI 54913-7743

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
I20240717004448 WI Practitioner - Nurse Practitioner 8527503200 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Thedacare, IncorporatedGroup PAC ID 1759294887, 654 clinicians

Practice addresses (Care Compare)

1818 N Meade St
Appleton, WI 54911-3454
Phone (920) 735-7645

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science - Nursing, Nurse Practitioner, Registered Nurse

State licenses

LicenseStateTypeSpecialty
15326-33WIMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Thedacare, Incorporated CurrentSince Jun 29, 2024 Accepting new patients
Thedacare Medical Center - Shawano, Inc. Past Accepting new patients

Locations

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

4480 W Spencer St
Appleton, WI 54914
Phone (920) 738-4800

225 Memorial Dr
Berlin, WI 54923
Phone (920) 361-1313

3 Neenah Ctr
Neenah, WI 54956
Phone (920) 454-4229

250 W 6th Ave
Oshkosh, WI 54902
Phone (920) 237-5000

600 N Westhaven Dr
Oshkosh, WI 54904
Phone (920) 237-5000

Interoperability endpoints

  • Direct secure messaging: jdegroot164689@direct.thedacare.org

Organizations & group practices 2

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 13

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1714953600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1714953600000",
    "number": "1669229720",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5680 N AMETHYST DR",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549137743"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1818 N MEADE ST",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549113454",
            "telephone_number": "920-731-8900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEGROOT",
        "first_name": "JAKE",
        "credential": "RN, MSN, FNP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2024-05-06",
        "last_updated": "2024-05-06",
        "certification_date": "2024-05-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "WI",
            "license": "15326-33",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Appleton, WI

Sources for this page

Verify at the official NPI Registry.