Individual provider Active NPI

Jennifer B Rickert, APNP

  • Family Nurse Practitioner
  • Campbellsport, WI
National Provider Identifier
1679209324
Registry record updated Jul 26, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
12100-33 Issued in WI
Practice address
350 E Sheboygan St
Campbellsport, WI 53010-2795
Phone
(920) 533-8361
NPI assigned
Jul 26, 2022
Last updated
Jul 26, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 26, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 12100-33 WI Primary

Addresses

Primary practice location

350 E Sheboygan St
Campbellsport, WI 53010-2795

Mailing address

748 W 8TH Ave
Oshkosh, WI 54902-5859
Phone (920) 312-1287

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220822001976 WI Practitioner - Nurse Practitioner 6103209317 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Agnesian Healthcare IncGroup PAC ID 1658289624, 392 clinicians

Practice addresses (Care Compare)

350 E Sheboygan St
Campbellsport, WI 53010-2795
Phone (920) 533-8361

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
12100-33WIMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Agnesian Healthcare, Inc Current Accepting new patients
Agnesian Healthcare Inc CurrentSince Aug 14, 2022 Accepting new patients
Agnesian Healthcare Inc CurrentSince Aug 14, 2022 Accepting new patients

Locations

145 N Main St
Fond du Lac, WI 54935
Phone (920) 926-4660

420 E Division St
Fond du Lac, WI 54935
Phone (920) 923-7400

1808 W Beltline Hwy
Madison, WI 53713
Phone (608) 250-1497

Interoperability endpoints

  • Direct secure messaging: jrickert331102@direct-ehr-ssmhc.com

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

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": "1658793600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658793600000",
    "number": "1679209324",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "748 W 8TH AVE",
            "city": "OSHKOSH",
            "state": "WI",
            "postal_code": "549025859",
            "telephone_number": "920-312-1287"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "350 E SHEBOYGAN ST",
            "city": "CAMPBELLSPORT",
            "state": "WI",
            "postal_code": "530102795",
            "telephone_number": "920-533-8361"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RICKERT",
        "first_name": "JENNIFER",
        "middle_name": "B",
        "name_prefix": "Miss",
        "credential": "APNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-07-26",
        "last_updated": "2022-07-26",
        "certification_date": "2022-06-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "WI",
            "license": "12100-33",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Campbellsport, WI

Sources for this page

Verify at the official NPI Registry.