Jessica Mijal, PSY.D, L.P.

Primary specialty

PsychologistTaxonomy code 103T00000X

License

3026-57 Issued in WI

Practice address

505 Broadway St
Baraboo, WI 53913-2183

Phone

(608) 355-4211

NPI assigned

Jun 14, 2012

Sex

Female

Sole proprietor

Yes

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 WI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 2010

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Sauk CountyGroup PAC ID 7618931148, 13 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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.

• Sauk County

  • Skilled Nursing Facility
  • Reedsburg, WI
  • NPI 1528056819

  WI

  Medicare reassignment Care Compare group NPD
• County of Sauk

  • Community/Behavioral Health Agency
  • Baraboo, WI
  • NPI 1508915323
  NPD Authorized official
• Sauk County

  • Public Health or Welfare Agency
  • Baraboo, WI
  • NPI 1962535088
  NPD

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

{
    "created_epoch": "1339632000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1339632000000",
    "number": "1982966958",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2005 TUMBLEWEED DR",
            "city": "PRAIRIE DU SAC",
            "state": "WI",
            "postal_code": "535781189",
            "telephone_number": "612-382-7593"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "505 BROADWAY ST",
            "city": "BARABOO",
            "state": "WI",
            "postal_code": "539132183",
            "telephone_number": "608-355-4211"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIJAL",
        "first_name": "JESSICA",
        "credential": "PSY.D, L.P.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-06-14",
        "last_updated": "2012-06-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "WI",
            "license": "3026-57",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Timothy James McReath, DDS
• Judith M Mehlos, PT
• Mark A Meier, MD
• Teresa M Mendoza, MD
• Michael D Plooster MD SC
• Elaena Miller, COTA
• Tayla Grace Minter, DC
• Montie Enterprises LLC
• Malarie J Montie, D.C
• Katelin Nolan Moody

• All providers in Baraboo, WI
• Psychologist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2012; 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.