Individual provider Active NPI

Jessica Anne Wallis-Bhyravabotla, FNP-C

  • Nurse Practitioner
  • Madison, WI
National Provider Identifier
1962879296
Registry record updated Feb 25, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
7559 Issued in WI
Practice address
600 Highland Ave
Madison, WI 53792-1840
Phone
(608) 265-1700
NPI assigned
Aug 21, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 25, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 7559 WI
Nurse Practitioner 363L00000X 7559 WI Primary

Addresses

Primary practice location

600 Highland Ave
Madison, WI 53792-1840

Mailing address

7974 Uw Health CT
Middleton, WI 53562-5531

Other identifiers 1

IdentifierTypeStateIssuer
209-013144OtherILIL APN LICENSE

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jwallis842638@direct.uwhealth.org

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20170516000957 WI Practitioner - Nurse Practitioner 3476862616 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
University of Wisconsin Medical Foundation IncGroup PAC ID 6608785464, 2,537 clinicians

Practice addresses (Care Compare)

2977 County Hwy CX
Portage, WI 53901
Phone (608) 742-3004

Hospital & facility affiliations

  • University of Wi Hospitals & Clinics Authority Hospital, Madison, WI, CCN 520098

Merit-based Incentive Payment System (MIPS)

Final score
83.32 of 100Reported as group
Quality
87.78
Promoting interoperability
77
Improvement activities
40
Cost
75.8

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
7559WIMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
University of Wisconsin Medical Foundation, Inc CurrentSince Jul 1, 2017 Accepting new patients
University of Wisconsin Medical Foundation, Inc CurrentSince Jul 1, 2017 Accepting new patients
University of Wisconsin Hospitals and Clinics Authority Past Accepting new patients
University of Wisconsin Medical Foundation Inc Past Accepting new patients

Locations

705 S University Ave
Ste 200
Beaver Dam, WI 53916
Phone (920) 887-9272

402 W Lake St
Friendship, WI 53934
Phone (608) 339-3331

1000 Mineral Point Ave
Janesville, WI 53548
Phone (608) 261-6868

600 Highland Ave
Madison, WI 53792
Phone (608) 263-0325

1100 Delaplaine Ct
Madison, WI 53715
Phone (608) 241-9020

7974 Uw Health Ct
Middleton, WI 53562
Phone (608) 829-5270

2977 Cty Cx
Portage, WI 53901
Phone (608) 742-3004

Interoperability endpoints

  • Direct secure messaging: jwallis842638@direct.uwhealth.org
  • Direct secure messaging: jdollerschell1206391@direct.uwhealth.org

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 1

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": "1440115200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1645747200000",
    "number": "1962879296",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7974 UW HEALTH CT",
            "city": "MIDDLETON",
            "state": "WI",
            "postal_code": "535625531"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 HIGHLAND AVE",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537921840",
            "telephone_number": "608-265-1700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLIS-BHYRAVABOTLA",
        "first_name": "JESSICA",
        "middle_name": "ANNE",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-08-21",
        "last_updated": "2022-02-25",
        "certification_date": "2022-02-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "WI",
            "license": "7559",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "WI",
            "license": "7559",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IL APN LICENSE",
            "identifier": "209-013144",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jwallis842638@direct.uwhealth.org",
            "affiliation": "N",
            "address_1": "6041 Basswood Dr",
            "city": "Fitchburg",
            "state": "WI",
            "country_code": "US",
            "postal_code": "537195102",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Madison, WI

Sources for this page

Verify at the official NPI Registry.