NPIMap

Individual provider Active NPI

Jennifer Jane McCormick, PA

  • Medical Physician Assistant
  • Neenah, WI
National Provider Identifier
1669423323
Registry record updated Feb 26, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
1908 Issued in WI
Practice address
300 N Commercial St
Suite 200
Neenah, WI 54956-2619
Phone
(920) 886-0818
Fax
(920) 886-0773
NPI assigned
May 15, 2006
Last updated
Feb 26, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 26, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 1908 WI Primary

Addresses

Primary practice location

300 N Commercial St
Suite 200
Neenah, WI 54956-2619

Mailing address

670 Cormier Rd
Green Bay, WI 54304-4824
Phone (920) 494-9685

Other identifiers 1

IdentifierTypeStateIssuer
42875200MedicaidWI

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
I20051020000425 WI Practitioner - Physician Assistant 4587680418 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Fox Valley Nephrology Partners S CGroup PAC ID 3870559404, 12 clinicians

Practice addresses (Care Compare)

300 N Commercial St
Suite 200
Neenah, WI 54956-2619
Phone (920) 886-0818

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
1908WIMDMedical Physician Assistant
10767MNMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
St Vincent Hospital-Hospital Sisters-Third Order of St Francis CurrentSince Feb 1, 2020 Accepting new patients
St Vincent Hospital-Hospital Sisters-Third Order of St Francis CurrentSince Feb 1, 2020 Accepting new patients
St Vincent Hospital-Hospital Sisters-Third Order of St Francis Past Accepting new patients
Thedacare Medical Center - Shawano, Inc. Past Accepting new patients

Locations

670 Cormier Rd
Green Bay, WI 54304
Phone (920) 494-9685

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

855 S Main St
Oconto Falls, WI 54154
Phone (920) 846-3444

Interoperability endpoints

  • Direct secure messaging: jmccormick276023@ewd.direct.hshs.org
  • Direct secure messaging: jmccormick32666@direct.thedacare.org

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.

Hospital & facility affiliations 12

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": "1147651200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1582675200000",
    "number": "1669423323",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "670 CORMIER RD",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543044824",
            "telephone_number": "920-494-9685"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 N COMMERCIAL ST",
            "address_2": "SUITE 200",
            "city": "NEENAH",
            "state": "WI",
            "postal_code": "549562619",
            "telephone_number": "920-886-0818",
            "fax_number": "920-886-0773"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCORMICK",
        "first_name": "JENNIFER",
        "middle_name": "JANE",
        "name_prefix": "Ms.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-15",
        "last_updated": "2020-02-26",
        "certification_date": "2020-02-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "WI",
            "license": "1908",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "42875200",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Neenah, WI

Sources for this page

Verify at the official NPI Registry.