Individual provider Active NPI

Jenna M Rickenbaugh, NP

  • Nurse Practitioner
  • Newburgh, IN
National Provider Identifier
1841809696
Registry record updated Aug 27, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
71010296A Issued in IN
Practice address
4015 Gateway Blvd
Newburgh, IN 47630-8925
Phone
(812) 858-6244
Fax
(812) 858-6240
NPI assigned
Jul 28, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 27, 2020

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 28220757A IN
Nurse Practitioner 363L00000X 71010296A IN Primary

Addresses

Primary practice location

4015 Gateway Blvd
Newburgh, IN 47630-8925

Mailing address

PO Box 1510
Evansville, IN 47706-1510
Phone (812) 450-6815

Other names 1

  • Jenna M Gogel Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
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
I20200831003359 IN Practitioner - Nurse Practitioner 2567889983 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Deaconess Clinic IncGroup PAC ID 3375610116, 411 clinicians

Practice addresses (Care Compare)

4015 Gateway Blvd
Newburgh, IN 47630-8925
Phone (812) 858-9400

Hospital & facility affiliations

  • Deaconess Hospital Inc Hospital, Evansville, IN, CCN 150082
  • The Women'S Hospital Hospital, Newburgh, IN, CCN 150149

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
28220757AINMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Deaconess Clinic, Inc Nurse Practitioner CurrentSince Aug 26, 2020 Accepting new patients
Deaconess Clinic Inc. Nurse Practitioner Current Accepting new patients
Deaconess Clinic Inc Nurse Practitioner CurrentSince Aug 26, 2020 Accepting new patients
Deaconess Clinic, Inc Nurse Practitioner Past Accepting new patients

Locations

421 Chestnut St
Evansville, IN 47713
Phone (812) 426-6645

4015 Gateway Blvd
Newburgh, IN 47630
Phone (812) 858-6244

1204 Williams St
Oakland City, IN 47660
Phone (812) 749-6187

Interoperability endpoints

  • Direct secure messaging: jgogel74873@direct.deaconess.com

Organizations & group practices 4

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 3

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": "1595894400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1598486400000",
    "number": "1841809696",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1510",
            "city": "EVANSVILLE",
            "state": "IN",
            "postal_code": "477061510",
            "telephone_number": "812-450-6815",
            "fax_number": "812-450-6822"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4015 GATEWAY BLVD",
            "city": "NEWBURGH",
            "state": "IN",
            "postal_code": "476308925",
            "telephone_number": "812-858-6244",
            "fax_number": "812-858-6240"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RICKENBAUGH",
        "first_name": "JENNA",
        "middle_name": "M",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-07-28",
        "last_updated": "2020-08-27",
        "certification_date": "2020-08-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IN",
            "license": "28220757A",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IN",
            "license": "71010296A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JENNA",
            "last_name": "GOGEL",
            "middle_name": "M",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Newburgh, IN

Sources for this page

Verify at the official NPI Registry.