Jordan Elizabeth Loose, APNP
Individual provider Active NPI Family Nurse Practitioner · Kiel, WI
NPI 1780429613 · NPPES record last updated Aug 13, 2024
Key facts
- NPI
- 1780429613
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 15537 (WI)
- Practice address
- 1160 Service Rd
Kiel, WI 53042-1281 - Phone
- (920) 894-3322
- NPI assigned
- Jul 1, 2024
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Hospital & facility affiliations 3
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2024
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Ascension Medical Group-Fox Valley Wisconsin, Inc
Practice addresses (Care Compare)
1160 Service Rd
Kiel, WI 53042-1281
Phone (920) 894-3322
Hospital & facility affiliations
- Calumet County HHC Agency
- Calumet County Hospice Agency
- Ascension Calumet Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240820001519 | WI | Practitioner - Nurse Practitioner | 9133667256 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ascension Medical Group-Fox Valley Wisconsin, Inc | Current |
Accepting new patients | |
| Ascension Medical Group-Fox Valley Wisconsin, Inc | Current |
Accepting new patients |
Locations
1501 S Madison St
Appleton, WI 54915
Phone (920) 730-4435
1160 Service Rd
Kiel, WI 53042
Phone (920) 894-3322
2700 W 9th Ave
Oshkosh, WI 54904
Phone (920) 223-0220
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 15537 | WI | Yes |
Addresses
Primary practice location
1160 Service Rd
Kiel, WI 53042-1281
Mailing address
N6291 Paul Rd
Brillion, WI 54110-9428
Phone (920) 901-6066
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100285361 | Medicaid | WI |
Other providers in Kiel, WI
- Kiel Veterinary Clinic
- Becky D Kissinger
- Jordyn Catherine Kohlmann
- Caitlin Moorea Kravick
- Dale Jeanne Lehrer
- David Maile
- Tony Matznick
- MH Health Care Services, PC
- Jody Muten
- Angelique Netzband-Fischer
All providers in Kiel, WI · Family Nurse Practitioner in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 13, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.