Active NPI
Jean Patrice Buckley
- Physician Assistant
- Stevens PT., WI
National Provider Identifier
1861542029
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 964
- Practice address
- 910 Fremont St
Stevens PT., WI 54481 - Phone
- (715) 346-5000
- NPI assigned
- Jan 11, 2007
- Last updated
- May 20, 2013
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 964 | WI | Primary |
Addresses
Primary practice location
910 Fremont St
Stevens PT., WI 54481
Mailing address
910 Fremont St.
Stevens PT, WI 54481
Phone (715) 346-4646
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 42966800 | Medicaid | WI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| University of Wisconsin System Non Payroll | Past | Accepting new patients | |
| University of Wisconsin System Non Payroll | Past | Accepting new patients |
Organizations & group practices 2
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.
-
dba UWSP Student Health Service
- Student Health Clinic/Center
- Stevens Point, WI
- NPI 1164680542
-
dba UW-Stevens Point Health Service Pharmacy
- Student Health Clinic/Center
- Stevens Point, WI
- NPI 1487849055
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168473600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1369008000000",
"number": "1861542029",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "910 FREMONT ST.",
"city": "STEVENS PT",
"state": "WI",
"postal_code": "54481",
"telephone_number": "715-346-4646"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "910 FREMONT ST",
"city": "STEVENS PT.",
"state": "WI",
"postal_code": "54481",
"telephone_number": "715-346-5000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BUCKLEY",
"first_name": "JEAN",
"middle_name": "PATRICE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-01-11",
"last_updated": "2013-05-20",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "WI",
"license": "964",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "42966800",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.