Jacqueline Susan Moe, APNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

2966-033 Issued in WI

Practice address

W3275 Wolf River Dr
Keshena, WI 54135-9202

Phone

(715) 799-3361

NPI assigned

Oct 12, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

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: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2006

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Menominee Indian Tribe of WisconsinGroup PAC ID 2668459264, 24 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Thedacare Regional Med Ctr - Neenah Hospital, Neenah, WI, CCN 520045
• Thedacare Medical Center - Shawano Hospital, Shawano, WI, CCN 521346

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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 and National Provider Directory roles.

• Menominee Indian Tribe of Wisconsin

  • Family Medicine Physician
  • Keshena, WI
  • NPI 1568404721
  Medicare reassignment Care Compare group NPD
• Thedacare, Incorporated

  • Family Medicine Physician
  • New London, WI
  • NPI 1376656959
  Medicare reassignment NPD
• Green Bay Emergency Medicine Services S.C.

  • Emergency Medicine Physician
  • Green Bay, WI
  • NPI 1366424111
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Thedacare Medical Center - Shawano, Inc.

  • Critical Access Hospital
  • Shawano, WI
  • NPI 1548260839
  Care Compare affiliation
• Thedacare Regional Medical Center - Neenah, Inc.

  • General Acute Care Hospital
  • Neenah, WI
  • NPI 1023472842
  Care Compare affiliation
• Thedacare Regional Medical Center - Neenah, Inc.

  • General Acute Care Hospital
  • Menasha, WI
  • NPI 1720434806
  Care Compare affiliation
• Thedacare Regional Medical Center-Neenah, Inc.

  • General Acute Care Hospital
  • Neenah, WI
  • NPI 1518993880
  Care Compare affiliation
• Thedacare Regional Medical Center-Neenah, Inc.

  • General Acute Care Hospital
  • Oshkosh, WI
  • NPI 1861943409
  Care Compare affiliation
• Thedcare Regional Medical Center - Neenah, Inc.

  • General Acute Care Hospital
  • Oshkosh, WI
  • NPI 1679937494
  Care Compare affiliation

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

{
    "created_epoch": "1160611200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1595980800000",
    "number": "1902995251",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 970",
            "city": "KESHENA",
            "state": "WI",
            "postal_code": "541350970",
            "telephone_number": "715-799-3361",
            "fax_number": "715-799-5854"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "W3275 WOLF RIVER DR",
            "city": "KESHENA",
            "state": "WI",
            "postal_code": "541359202",
            "telephone_number": "715-799-3361"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOE",
        "first_name": "JACQUELINE",
        "middle_name": "SUSAN",
        "credential": "APNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-12",
        "last_updated": "2020-07-29",
        "certification_date": "2020-07-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "WI",
            "license": "2966-033",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "WI",
            "license": "2966-033",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "36015400",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Menominee Indian Tribe of Wisconsin
• Menominee Indian Tribe of Wisconsin
• Menominee Indian Tribe of Wisconsin
• Menominee Indian Tribe of Wisconsin
• Menominee Indian Tribe of Wisconsin
• Mary Nahwahquaw, CSAC
• Heather Marie Nennig, MD
• Michael J O'Neill, M.D.
• Jodi L. Opper
• Estelle Ostgard, MD

• Family Nurse Practitioner in Keshena, WI
• Providers in Keshena, WI by specialty
• Family Nurse Practitioner in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2020; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.