Individual provider Active NPI

Jackson Nguyen, MD

  • Family Medicine Physician
  • West Bend, WI
National Provider Identifier
1700381977
Registry record updated Dec 2, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
73277 Issued in WI
Practice address
1700 W Paradise Dr
West Bend, WI 53095-9795
Phone
(262) 334-3451
NPI assigned
Mar 28, 2018
Last updated
Dec 2, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 2, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Family Medicine Physician 207Q00000X 73277 WI Primary

Addresses

Primary practice location

1700 W Paradise Dr
West Bend, WI 53095-9795

Mailing address

1700 W Paradise Dr
West Bend, WI 53095-9795
Phone (262) 334-3451

Other identifiers 1

IdentifierTypeStateIssuer
100099356MedicaidWI

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210616001023 WI Practitioner - Family Practice 3072933050 Reassigns benefits to 6 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

1700 W Paradise Dr
West Bend, WI 53095-9795
Phone (262) 334-3451

W168N11237 Western Ave
Germantown, WI 53022-3239
Phone (262) 253-5060

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Lakeshore Medical Clinic, LLC Family Medicine CurrentSince Dec 30, 2021 Accepting new patients
Columbia St. Mary's Hospital Milwaukee, Inc Family Medicine CurrentSince Feb 22, 2023 Accepting new patients
Froedtert &the Medical College of Wisconsin Community Physicians, Inc. CurrentSince Nov 1, 2024 Accepting new patients
Aurora Advanced Healthcare, Inc. Family Medicine CurrentSince Dec 30, 2021 Accepting new patients
Aurora Medical Group, Inc. CurrentSince Dec 30, 2021 Accepting new patients
Columbia St. Mary's Hospital Milwaukee Inc CurrentSince Feb 22, 2023 Accepting new patients
Aurora Medical Group, Inc. Family Medicine CurrentSince Dec 30, 2021 Accepting new patients
Aurora Advanced Healthcare Inc CurrentSince Dec 30, 2021 Accepting new patients
Froedtert &the Medical College of Wisconsin Community Physicians, Inc. CurrentSince Nov 1, 2024 Accepting new patients
Ascension Medical Group-Southeast Wisconsin Inc Family Medicine CurrentSince Jun 8, 2021 Accepting new patients

Locations

13950 W Capitol Dr
Brookfield, WI 53005
Phone (414) 302-5400

W168N11237 Western Ave
Germantown, WI 53022
Phone (262) 253-5060

2400 W Villard Ave
Glendale, WI 53209
Phone (414) 527-8000

3003 W Good Hope Rd
Glendale, WI 53209
Phone (414) 352-3100

N74W12501 Leatherwood Ct
Menomonee Falls, WI 53051
Phone (414) 454-4744

12203 N Corporate Pkwy
Mequon, WI 53092
Phone (262) 387-8200

1020 N 12th St
Milwaukee, WI 53233
Phone (414) 219-3056

2025 W Oklahoma Ave
Ste 100
Milwaukee, WI 53215
Phone (414) 389-2790

2311 N Prospect Ave
Milwaukee, WI 53211
Phone (414) 319-3000

6901 W Edgerton Ave
Milwaukee, WI 53220
Phone (414) 325-5244

2000 E Layton Ave
St Francis, WI 53235
Phone (414) 744-7880

13111 N Port Washington Rd
Thiensville, WI 53097
Phone (262) 243-7300

1155 N Mayfair Rd
Wauwatosa, WI 53226
Phone (414) 955-5990

201 N Mayfair Rd
Fl 2
Wauwatosa, WI 53226
Phone (414) 771-8228

9200 W Wisconsin Ave
Wauwatosa, WI 53226
Phone (414) 259-3000

801 S 70th St
West Allis, WI 53214
Phone (414) 773-6600

1700 W Paradise Dr
West Bend, WI 53095
Phone (262) 334-3451

Interoperability endpoints

  • Direct secure messaging: jnguyen684475@direct.froedtert.com

Organizations & group practices 10

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 2

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": "1522195200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733097600000",
    "number": "1700381977",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1700 W PARADISE DR",
            "city": "WEST BEND",
            "state": "WI",
            "postal_code": "530959795",
            "telephone_number": "262-334-3451"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1700 W PARADISE DR",
            "city": "WEST BEND",
            "state": "WI",
            "postal_code": "530959795",
            "telephone_number": "262-334-3451"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NGUYEN",
        "first_name": "JACKSON",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-03-28",
        "last_updated": "2024-12-02",
        "certification_date": "2024-12-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "73277",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100099356",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in West Bend, WI

Sources for this page

Verify at the official NPI Registry.