Jaclyn T Peissig, NP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

13831-33 Issued in WI

Practice address

103 1St Ave W
Menomonie, WI 54751-1876

Phone

(715) 232-1314

NPI assigned

Apr 17, 2023

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Jaclyn T Miller Former name

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: jaclyn.peissig.1@32401.direct.athenahealth.com

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.

• Prevea Clinic, Inc.

  • Internal Medicine Physician
  • Green Bay, WI
  • NPI 1306869276
  NPD (past)

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

{
    "created_epoch": "1681689600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718668800000",
    "number": "1790471332",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1702 FOX RUN",
            "city": "MENOMONIE",
            "state": "WI",
            "postal_code": "547511401"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "103 1ST AVE W",
            "city": "MENOMONIE",
            "state": "WI",
            "postal_code": "547511876",
            "telephone_number": "715-232-1314"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEISSIG",
        "first_name": "JACLYN",
        "middle_name": "T",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-04-17",
        "last_updated": "2024-06-18",
        "certification_date": "2024-06-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "WI",
            "license": "13831-33",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100248089",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jackyp@studenthc.com",
            "affiliation": "Y",
            "affiliationName": "Employee Health Centre, LLC",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "103 1st Ave W",
            "city": "Menomonie",
            "state": "WI",
            "country_code": "US",
            "postal_code": "547511876",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "JACLYN",
            "last_name": "MILLER",
            "middle_name": "T",
            "credential": "NP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Brandon L. Parkhurst, MD
• Margaret Rose Paulson, D.O.
• Jillian Pechacek
• Margaret Peinovich, PHARMD
• Grant J Peissig, D.C.
• Victoria Rose Perron
• James Scott Persing, MD
• Alicia Peterson, MSW, APSW
• Shane C Peterson, D.C.
• Steven R Peterson, DDS SC

• Nurse Practitioner in Menomonie, WI
• Providers in Menomonie, WI by specialty
• Nurse Practitioner in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.