Individual provider Active NPI

Jason William Nobles, DC

  • Chiropractor
  • Green Bay, WI
National Provider Identifier
1740272848
Registry record updated Jan 6, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
3964-012 Issued in WI
Practice address
2525 W Mason St
Green Bay, WI 54303-4838
Phone
(920) 429-2844
NPI assigned
Aug 16, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 6, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 3964-012 WI Primary

Addresses

Primary practice location

2525 W Mason St
Green Bay, WI 54303-4838

Mailing address

2525 W Mason St
Green Bay, WI 54303-4838
Phone (920) 429-2844

Other identifiers 2

IdentifierTypeStateIssuer
201908273012OtherWIBLUE CROSS/BLUE SHIELD
38948100MedicaidWI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040131000143 WI Practitioner - Chiropractic 0840193256 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Palmer College Chiropractic - Davenport, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
The Wellness Way Green Bay LLCGroup PAC ID 4284680463, 3 clinicians

Practice addresses (Care Compare)

2525 W Mason St
Green Bay, WI 54303-4838
Phone (920) 429-2845

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
3964-012WIMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
The Wellness Way Green Bay LLC Chiropractor CurrentSince Mar 21, 2011 Accepting new patients
Habeck Chiropractic Center, LLC Chiropractor Past Accepting new patients

Locations

2525 W Mason St
Green Bay, WI 54303
Phone (920) 429-2844

2638 Tulip Ln
Ste B
Green Bay, WI 54313
Phone (920) 429-2844

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1124150400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1609891200000",
    "number": "1740272848",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2525 W MASON ST",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543034838",
            "telephone_number": "920-429-2844"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2525 W MASON ST",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543034838",
            "telephone_number": "920-429-2844"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NOBLES",
        "first_name": "JASON",
        "middle_name": "WILLIAM",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-16",
        "last_updated": "2021-01-06",
        "certification_date": "2021-01-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "WI",
            "license": "3964-012",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS/BLUE SHIELD",
            "identifier": "201908273012",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "38948100",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Green Bay, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.