Individual provider Active NPI

Jessica E Schutta, NP

  • Family Nurse Practitioner
  • Milwaukee, WI
National Provider Identifier
1780965657
Registry record updated Sep 7, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
4515-033 Issued in WI
Practice address
3237 S 16TH St
Milwaukee, WI 53215-4526
Phone
(414) 647-5000
NPI assigned
Sep 6, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 7, 2017

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 4515-033 WI
Family Nurse Practitioner 363LF0000X 4515-033 WI Primary

Addresses

Primary practice location

3237 S 16TH St
Milwaukee, WI 53215-4526

Mailing address

10625 W North Ave
Suite 102
Milwaukee, WI 53226-2315
Phone (414) 877-5350

Other names 1

  • Jessica E Vanderboom Former name

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
I20111123000516 WI Practitioner - Nurse Practitioner 5597939819 Reassigns benefits to 2 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
Emergency Medicine Specialists SCGroup PAC ID 8729975461, 220 clinicians

Practice addresses (Care Compare)

10180 Washington Ave
Mount Pleasant, WI 53177-1604
Phone (262) 687-7550

201 N Mayfair Rd
Wauwatosa, WI 53226-4216
Phone (414) 259-7200

3237 S 16TH St
Milwaukee, WI 53215-4526
Phone (414) 647-5000

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

3807 Spring St
Mount Pleasant, WI 53405-1667
Phone (262) 687-8173

5000 W Chambers St
Milwaukee, WI 53210-1650
Phone (414) 447-2000

Hospital & facility affiliations

  • Ascension All Saints Hospital Hospital, Racine, WI, CCN 520096

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4515-033WIMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Ascension Medical Group-Southeast Wisconsin Inc Nurse Practitioner CurrentSince Feb 1, 2016 Accepting new patients
Integrated Therapeutic Massage LLC PastSince Aug 1, 2021 Accepting new patients

Locations

1506 S Oneida St
Appleton, WI 54915
Phone (920) 730-4950

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

10101 S 27th St
Franklin, WI 53132
Phone (414) 325-4700

375 W River Woods Pkwy
Glendale, WI 53212
Phone (414) 326-1500

2301 N Lake Dr
Milwaukee, WI 53211
Phone (414) 270-4932

3237 S 16th St
Milwaukee, WI 53215
Phone (414) 647-5000

5000 W Chambers St
Milwaukee, WI 53210
Phone (414) 447-2089

3801 Spring St
Mount Pleasant, WI 53405
Phone (262) 636-4011

500 S Oakwood Rd
Oshkosh, WI 54904
Phone (920) 223-0501

13111 N Port Washington Rd
Thiensville, WI 53097
Phone (262) 243-7300

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

201 N Mayfair Rd
Wauwatosa, WI 53226
Phone (414) 259-7200

Organizations & group practices 3

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": "1315267200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1504742400000",
    "number": "1780965657",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10625 W NORTH AVE",
            "address_2": "SUITE 102",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532262315",
            "telephone_number": "414-877-5350",
            "fax_number": "414-877-5360"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3237 S 16TH ST",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532154526",
            "telephone_number": "414-647-5000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SCHUTTA",
        "first_name": "JESSICA",
        "middle_name": "E",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-09-06",
        "last_updated": "2017-09-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "WI",
            "license": "4515-033",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "WI",
            "license": "4515-033",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JESSICA",
            "last_name": "VANDERBOOM",
            "middle_name": "E",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Milwaukee, WI

Sources for this page

Verify at the official NPI Registry.