Individual provider Active NPI

Shannon K Jacobi, NP

  • Nurse Practitioner
  • Franklin, WI
National Provider Identifier
1760760391
Registry record updated Mar 3, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
4466-33 Issued in WI
Practice address
3111 W Rawson Ave
Suite 200
Franklin, WI 53132-9417
Phone
(414) 384-6700
Fax
(414) 761-1921
NPI assigned
Aug 1, 2011
Last updated
Mar 3, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 3, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 4466-33 WI Primary

Addresses

Primary practice location

3111 W Rawson Ave
Suite 200
Franklin, WI 53132-9417

Mailing address

3077 N Mayfair Rd Ste 305
Wauwatosa, WI 53222-4305
Phone (414) 384-6700

Other identifiers 1

IdentifierTypeStateIssuer
1760760391MedicaidWI

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
I20110811000362 WI Practitioner - Nurse Practitioner 2163691908 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Orthopedic Surgeons of Wisconsin SCGroup PAC ID 5294727152, 61 clinicians

Practice addresses (Care Compare)

13950 W Capitol Dr
Brookfield, WI 53005-2441
Phone (414) 302-5400

3111 W Rawson Ave
Suite 200
Franklin, WI 53132-8890
Phone (414) 384-6700

3801 Spring St
Mount Pleasant, WI 53405-1667
Phone (262) 687-4011

3807 Spring St
Mount Pleasant, WI 53405-1667
Phone (262) 687-8300

3809 Spring St
Mount Pleasant, WI 53405-1667
Phone (262) 687-5000

3811 Spring St
Mount Pleasant, WI 53405-1667

3821 Spring St
Mount Pleasant, WI 53405-1667
Phone (262) 687-8460

7095 S Ballpark Dr
Suite 100
Franklin, WI 53132-6908
Phone (414) 817-6620

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
81.61 of 100Reported as group
Quality
73.65
Promoting interoperability
87
Improvement activities
40

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Midwest Orthopedic Specialty Hospital, LLC Current Accepting new patients
Orthopedic Surgeons of Wisconsin, S.C. Nurse Practitioner CurrentSince Jul 27, 2011 Accepting new patients
Ascension Medical Group-Southeast Wisconsin Inc Nurse Practitioner CurrentSince Aug 15, 2011 Accepting new patients
Midwest Orthopedic Specialty Hospital, LLC CurrentSince Jan 14, 2024 Accepting new patients
Midwest Orthopedic Specialty Hospital, LLC CurrentSince Jan 14, 2024 Accepting new patients

Locations

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

17000 W Bluemound Rd
Ste L
Brookfield, WI 53005
Phone (262) 207-4680

3111 W Rawson Ave
Ste 200
Franklin, WI 53132
Phone (414) 325-4320

3111 W Rawson Ave
Ste 215
Franklin, WI 53132
Phone (414) 761-0727

7095 S Ballpark Dr
Unit 100
Franklin, WI 53132
Phone (414) 817-6620

9969 S 27th St
#1100
Franklin, WI 53132

9969 S 27th St
Ste 1100
Franklin, WI 53132

2901 W Kinnickinnic River Pkwy
Ste 102
Milwaukee, WI 53215
Phone (414) 385-7150

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

2323 N Mayfair Rd
Ste 300
Wauwatosa, WI 53226
Phone (414) 443-9862

3077 N Mayfair Rd
Ste 305
Wauwatosa, WI 53222
Phone (414) 258-3500

Interoperability endpoints

  • Direct secure messaging: shannon.jacobi.1@32957.direct.athenahealth.com

Organizations & group practices 5

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 3

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": "1312156800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1583193600000",
    "number": "1760760391",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3077 N MAYFAIR RD STE 305",
            "city": "WAUWATOSA",
            "state": "WI",
            "postal_code": "532224305",
            "telephone_number": "414-384-6700",
            "fax_number": "414-727-1058"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3111 W RAWSON AVE",
            "address_2": "SUITE 200",
            "city": "FRANKLIN",
            "state": "WI",
            "postal_code": "531329417",
            "telephone_number": "414-384-6700",
            "fax_number": "414-761-1921"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOBI",
        "first_name": "SHANNON",
        "middle_name": "K",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-08-01",
        "last_updated": "2020-03-03",
        "certification_date": "2020-03-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "WI",
            "license": "4466-33",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1760760391",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Franklin, WI

Sources for this page

Verify at the official NPI Registry.