Individual provider Active NPI

Jeanette Di Everson, MD

  • Family Medicine Physician
  • Madison, WI
National Provider Identifier
1720047780
Registry record updated Oct 17, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
37004 Issued in WI
Practice address
5249 E Terrace Dr
Madison, WI 53718-8339
Phone
(608) 222-9777
Fax
(608) 441-3961
NPI assigned
Mar 20, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 17, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 37004 WI Primary

Addresses

Primary practice location

5249 E Terrace Dr
Madison, WI 53718-8339

Mailing address

5249 E Terrace Dr
Madison, WI 53718-8339
Phone (608) 222-9777

Other identifiers 1

IdentifierTypeStateIssuer
32335300MedicaidWI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
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
I20151211000190 MN Practitioner - Family Practice 5890770937 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Medical College of Wisconsin, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

980 Rice St
Saint Paul, MN 55117-4949
Phone (651) 326-9020

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of nail tissue1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
37004WIMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Healtheast Medical Research Institute CurrentSince Nov 16, 2015 Accepting new patients
Healtheast Medical Research Institute Current Accepting new patients
Healtheast Medical Research Institute Current Accepting new patients
Healtheast Medical Research Institute Family Medicine Current Accepting new patients
Healtheast Medical Research Institute Current Accepting new patients
Healtheast Medical Research Institute Current Accepting new patients
Healtheast Medical Research Institute Current Accepting new patients
Healtheast Medical Research Institute CurrentSince Nov 16, 2015 Accepting new patients
Healtheast Medical Research Institute Current Accepting new patients

Locations

6936 Pine Arbor Dr S
Ste 100
Cottage Grove, MN 55016
Phone (651) 326-5800

14688 Everton Ave N
Ste 101
Hugo, MN 55038
Phone (651) 275-4706

2945 Hazelwood St
Ste 100
Saint Paul, MN 55109
Phone (651) 232-7800

870 Grand Ave
Saint Paul, MN 55105
Phone (651) 326-5650

1983 Sloan Pl
Ste 1
Saint Paul, MN 55117
Phone (651) 326-5700

2945 Hazelwood St
Ste 200
Saint Paul, MN 55109
Phone (612) 440-6315

2680 Snelling Ave N
Ste 200
Saint Paul, MN 55113
Phone (651) 326-1600

1700 University Ave W
Fl 6
Saint Paul, MN 55104
Phone (651) 232-2273

1700 University Ave W
Fl 1
Saint Paul, MN 55104
Phone (651) 232-2002

980 Rice St
Saint Paul, MN 55117
Phone (651) 326-9020

1099 Helmo Ave N
Ste 100
Saint Paul, MN 55128
Phone (651) 326-5300

2900 Curve Crest Blvd W
Stillwater, MN 55082
Phone (651) 471-5600

480 Highway 96 E
Vadnais Heights, MN 55127
Phone (651) 326-5900

1875 Woodwinds Dr
Woodbury, MN 55125
Phone (651) 232-6700

Interoperability endpoints

  • Direct secure messaging: jeverson628340@fairview.direct-ci.com

Organizations & group practices 9

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 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": "1142812800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1350432000000",
    "number": "1720047780",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5249 E TERRACE DR",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537188339",
            "telephone_number": "608-222-9777",
            "fax_number": "608-441-3961"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5249 E TERRACE DR",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537188339",
            "telephone_number": "608-222-9777",
            "fax_number": "608-441-3961"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EVERSON",
        "first_name": "JEANETTE",
        "middle_name": "DI",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-20",
        "last_updated": "2012-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "37004",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "32335300",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Madison, WI

Sources for this page

Verify at the official NPI Registry.