Jordan Fraser, DO

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

74203-21 Issued in WI

Practice address

257 W Saint George Ave
Grantsburg, WI 54840-7827

Phone

(715) 463-5353

NPI assigned

Jul 3, 2019

Last updated

Oct 14, 2022By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jfraser641799@direct.ochin.org

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.

• Burnett Medical Center Inc

  • Critical Access Hospital
  • Grantsburg, WI
  • NPI 1225191687
  Medicare reassignment NPD
• Burnett Medical Center Inc

  dba Burnett Medical Center

  • Rural Health Clinic/Center
  • Grantsburg, WI
  • NPI 1356499784

  Family Medicine

  Medicare reassignment NPD
• Burnett Medical Center Inc

  • Skilled Nursing Facility
  • Grantsburg, WI
  • NPI 1487703815
  NPD

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

{
    "created_epoch": "1562112000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1665705600000",
    "number": "1821650466",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "257 W SAINT GEORGE AVE",
            "city": "GRANTSBURG",
            "state": "WI",
            "postal_code": "548407827",
            "telephone_number": "715-463-5353"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "257 W SAINT GEORGE AVE",
            "city": "GRANTSBURG",
            "state": "WI",
            "postal_code": "548407827",
            "telephone_number": "715-463-5353"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FRASER",
        "first_name": "JORDAN",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-07-03",
        "last_updated": "2022-10-14",
        "certification_date": "2022-08-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "74203-21",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Daina Marie Duerr, RD, LD, CD
• Patricia Eid, NP
• Barbara Everson, RN
• Jenna Sue Fickbohm, L.P.N
• Robyn Marie Formanek, P.T.
• Kathleen M French, PT
• Gary L Kaefer DDS SC
• Gretchen Jean Gerovac, NP
• Janelle R. Gomez, MSRDCD
• Debra Harris Hammer, CNM

• Family Medicine Physician in Grantsburg, WI
• Providers in Grantsburg, WI by specialty
• Family Medicine Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2022; 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.