Jaclyn Benish

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

5825 Issued in WI

Practice address

311 E Tyranena Park Rd
Lake Mills, WI 53551-9681

Phone

(920) 648-2331

Fax

(920) 648-3437

NPI assigned

Jan 31, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Jaclyn Blechschmidt Former name

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: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

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.

• Dental Associates of Lake Mills, Inc.

  • Dentist
  • Lake Mills, WI
  • NPI 1629224852
  NPD (past)

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

{
    "created_epoch": "1170201600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1245024000000",
    "number": "1942347604",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "311 E TYRANENA PARK RD",
            "city": "LAKE MILLS",
            "state": "WI",
            "postal_code": "535519681",
            "telephone_number": "920-648-2331",
            "fax_number": "920-648-3437"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "311 E TYRANENA PARK RD",
            "city": "LAKE MILLS",
            "state": "WI",
            "postal_code": "535519681",
            "telephone_number": "920-648-2331",
            "fax_number": "920-648-3437"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BENISH",
        "first_name": "JACLYN",
        "name_prefix": "Dr.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-31",
        "last_updated": "2009-06-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WI",
            "license": "5825",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JACLYN",
            "last_name": "BLECHSCHMIDT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Assisted Living Concepts Inc
• Aurora Pharmacy Inc
• Elizabeth Frances Balsiger, MS, CCC-SLP
• Hannah Baneck
• Jessica Eva Beck, CRNA, APRN
• Nicole Lee Berg-Johnson, FNP
• Tracy L Bergum, MSN, FNP-C, APNP
• Jennifer Bohnert, RN
• Dawnine Marie Boldon, LPTA
• Shelly L. Borges, R.N.

• General Practice Dentistry in Lake Mills, WI
• Providers in Lake Mills, WI by specialty
• General Practice Dentistry in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2009; 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.