Individual provider Active NPI

Jennifer Beth Grube

  • Counselor
  • Menasha, WI
National Provider Identifier
1780866756
Registry record updated Dec 3, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
CounselorTaxonomy code 101Y00000X
License
3685 Issued in WI
Practice address
1095 Midway Rd
Menasha, WI 54952-1115
Phone
(920) 720-2300
Fax
(920) 720-3806
NPI assigned
Dec 3, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 3, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Counselor 101Y00000X 3685 WI Primary

Addresses

Primary practice location

1095 Midway Rd
Menasha, WI 54952-1115

Mailing address

1095 Midway Rd
Menasha, WI 54952-1115
Phone (920) 720-2300

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: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240823003315 WI Practitioner - Mental Health Counselor 7911446794 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Farrar and Associates Mental Health SCGroup PAC ID 4981031309, 9 clinicians

Practice addresses (Care Compare)

16 Tri Park Way
Appleton, WI 54914-1658
Phone (920) 841-8326

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
3685WIMDCounselor

Practice roles

OrganizationSpecialtyStatusNew patients
Farrar and Associates Mental Health SC CurrentSince Jun 13, 2024 Accepting new patients

Locations

16 Tri Park Way
Appleton, WI 54914
Phone (920) 841-8326

Organizations & group practices 1

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": "1196640000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1196640000000",
    "number": "1780866756",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1095 MIDWAY RD",
            "city": "MENASHA",
            "state": "WI",
            "postal_code": "549521115",
            "telephone_number": "920-720-2300",
            "fax_number": "920-720-3806"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1095 MIDWAY RD",
            "city": "MENASHA",
            "state": "WI",
            "postal_code": "549521115",
            "telephone_number": "920-720-2300",
            "fax_number": "920-720-3806"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRUBE",
        "first_name": "JENNIFER",
        "middle_name": "BETH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-12-03",
        "last_updated": "2007-12-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "WI",
            "license": "3685",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Menasha, WI

Sources for this page

Verify at the official NPI Registry.