NPIMap

Individual provider Active NPI

Bentley Jessica Mae Thomason, MD

  • Family Medicine Physician
  • Shawano, WI
National Provider Identifier
1699112482
Registry record updated Jan 4, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
76345 Issued in WI
Practice address
100 County Road B
Shawano, WI 54166-7072
Phone
(715) 524-2161
NPI assigned
Jun 3, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 4, 2022

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X A133000 CA
Obstetrics & Gynecology Physician 207V00000X 76345 WI
Family Medicine Physician 207Q00000X 76345 WI Primary
Family Medicine Physician 207Q00000X M-13560 ID

Addresses

Primary practice location

100 County Road B
Shawano, WI 54166-7072

Mailing address

3 Neenah Ctr
Neenah, WI 54956-3070
Phone (715) 524-2161

Other practice location 1

218 W Nez Perce
Jerome, ID 83338-5193
Phone (208) 324-3471

Other names 1

  • Dr. Jessica Mae Bentley Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA, WI2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20170825000702 WA Practitioner - Family Practice 7618258526 Reassigns benefits to 1 organization
I20220112001007 WI Practitioner - Family Practice 7618258526 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Irvine California College of Medicine, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Thedacare, IncorporatedGroup PAC ID 1759294887, 654 clinicians
Thedacare Medical Center - Shawano, Inc.Group PAC ID 5890605836, 38 clinicians

Practice addresses (Care Compare)

100 County Rd B
Shawano, WI 54166-7072
Phone (920) 358-1223

Hospital & facility affiliations

  • Thedacare at Home Hospice, Appleton, WI, CCN 521504
  • Thedacare Medical Center - Shawano Hospital, Shawano, WI, CCN 521346
  • Thedacare Regional Med Ctr - Neenah Hospital, Neenah, WI, CCN 520045
  • Thedacare Regional Medical Center - Appleton Inc Hospital, Appleton, WI, CCN 520160

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
133000CAMDMarriage & Family Therapist
A133000CAMDFamily Medicine Physician
M-13560IDMDFamily Medicine Physician
76345WIMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Multicare Health System Family Medicine CurrentSince Jul 19, 2017 Accepting new patients
Multicare Health System CurrentSince Jul 19, 2017 Accepting new patients
Thedacare, Incorporated Family Medicine CurrentSince Jan 1, 2022 Accepting new patients
Multicare Health System Current Accepting new patients
Thedacare Medical Center - Shawano, Inc. CurrentSince Jan 10, 2022 Accepting new patients
Thedacare Medical Center - Shawano, Inc. CurrentSince Jan 10, 2022 Accepting new patients
Thedacare Medical Center - Wild Rose, Inc CurrentSince Jan 24, 2026 Accepting new patients
Thedacare Medical Center - Berlin, Inc. Past Accepting new patients

Locations

4700 Point Fosdick Dr
Ste 104
Gig Harbor, WA 98335
Phone (253) 459-7590

222 State Ave N
Kent, WA 98030
Phone (253) 372-7680

521 S K St
Tacoma, WA 98405
Phone (253) 403-2900

315 S K St
Tacoma, WA 98405
Phone (253) 403-1291

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

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

100 Cty Road B
Shawano, WI 54166
Phone (715) 524-2161

601 Grove Ave
Wild Rose, WI 54984
Phone (888) 287-4488

Interoperability endpoints

  • Direct secure messaging: bthomason318666@direct.thedacare.org

Organizations & group practices 8

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 14

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

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1370217600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1641254400000",
    "number": "1699112482",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3 NEENAH CTR",
            "city": "NEENAH",
            "state": "WI",
            "postal_code": "549563070",
            "telephone_number": "715-524-2161",
            "fax_number": "715-524-8164"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 COUNTY ROAD B",
            "city": "SHAWANO",
            "state": "WI",
            "postal_code": "541667072",
            "telephone_number": "715-524-2161"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "218 W Nez Perce",
            "address_purpose": "LOCATION",
            "city": "Jerome",
            "state": "ID",
            "postal_code": "833385193",
            "country_code": "US",
            "telephone_number": "208-324-3471",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "THOMASON",
        "first_name": "BENTLEY",
        "middle_name": "JESSICA MAE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-06-03",
        "last_updated": "2022-01-04",
        "certification_date": "2022-01-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A133000",
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "WI",
            "license": "76345",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "76345",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "ID",
            "license": "M-13560",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JESSICA",
            "last_name": "BENTLEY",
            "middle_name": "MAE",
            "prefix": "DR.",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Shawano, WI

Sources for this page

Verify at the official NPI Registry.