Jack Wenkel, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

2008031587 Issued in MO

Practice address

605C Douglas Dr
Ashland, MO 65010-9088

Phone

(573) 657-9354

Fax

(573) 657-9694

NPI assigned

Oct 8, 2008

Last updated

May 24, 2022By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MO

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• Capital Emergency Physicians, PC

  • Emergency Medicine Physician
  • Jefferson City, MO
  • NPI 1871626309
  Medicare reassignment
• Noble Health Audrain Inc

  dba Sedalia Specialty Clinic

  • Orthopaedic Surgery Physician
  • Sedalia, MO
  • NPI 1043944499
  NPD
• Missouri Emergency Services, P.C.

  • Emergency Medicine Physician
  • Pleasanton, CA
  • NPI 1134499049
  NPD (past)

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

{
    "created_epoch": "1223424000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1653350400000",
    "number": "1891946877",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "605C DOUGLAS DR",
            "city": "ASHLAND",
            "state": "MO",
            "postal_code": "650109088",
            "telephone_number": "573-657-9354",
            "fax_number": "573-657-9694"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "605C DOUGLAS DR",
            "city": "ASHLAND",
            "state": "MO",
            "postal_code": "650109088",
            "telephone_number": "573-657-9354",
            "fax_number": "573-657-9694"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WENKEL",
        "first_name": "JACK",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-10-08",
        "last_updated": "2022-05-24",
        "certification_date": "2022-05-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MO",
            "license": "2008031587",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cindy Underwood-Mortrud
• Virginia Vandenberghe
• Allison Walker
• Benjamin A Wall, MA, LPC
• Katherine Anne Walters, CPS
• Kimberly Westhoff, OTR
• John Henry Williams
• Jodie Ann Withington, SLP
• Melissa D Zars, MHS, CF-SLP
• Zentry Ai Inc

• Physician Assistant in Ashland, MO
• Providers in Ashland, MO by specialty
• Physician Assistant in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 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.