Eric L. Jenison, M.D.

Primary specialty

Gynecologic Oncology PhysicianTaxonomy code 207VX0201X

License

59856 Issued in WI

Practice address

704 S Webster Ave
Suite 100
Green Bay, WI 54301-3528

Phone

(920) 433-3430

Fax

(920) 432-6313

NPI assigned

Jun 14, 2005

Last updated

Sep 18, 2014By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in OH

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

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.

• Mercy Health Physicians-North LLC

  • Family Medicine Physician
  • Toledo, OH
  • NPI 1609000769
  Medicare reassignment NPD
• Mercy Health Physicians - North, LLC

  dba Mercy Health - Perrysburg Podiatry

  • Customized Equipment (DME)
  • Perrysburg, OH
  • NPI 1992358766
  NPD
• Gynecologic Oncologists of Northeastern Ohio, Inc.

  • Gynecologic Oncology Physician
  • Akron, OH
  • NPI 1265528335
  NPD (past)

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

{
    "created_epoch": "1118707200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1410998400000",
    "number": "1669477071",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 22487",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543052487",
            "telephone_number": "920-445-7210",
            "fax_number": "920-445-7289"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "704 S WEBSTER AVE",
            "address_2": "SUITE 100",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543013528",
            "telephone_number": "920-433-3430",
            "fax_number": "920-432-6313"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JENISON",
        "first_name": "ERIC",
        "middle_name": "L.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-14",
        "last_updated": "2014-09-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "OH",
            "license": "038252",
            "primary": false
        },
        {
            "code": "207VX0201X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Gynecologic Oncology",
            "state": "WI",
            "license": "59856",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0288531",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1669477071",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mohammad R Jazayeri, MD
• Tarek Jazmati, MD
• Daniel D Jean-Baptiste, CRNA
• Shirley M Jean-Baptiste, APNP
• Taylor Nicole Jean, CHWC, NBHWC, CPT
• John W Jenkins, PA-C
• Rebecca Jenkins, PA-C
• Nicholas Jenquin
• Benjamin James Jensen, MD
• Jennifer Marie Jensen, AGPC-NP

• Gynecologic Oncology Physician in Green Bay, WI
• Providers in Green Bay, WI by specialty
• Gynecologic Oncology Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.