NPIMap

Individual provider Active NPI

Jeffrey Allen Fillmore, APNP

  • Family Nurse Practitioner
  • New London, WI
National Provider Identifier
1992382873
Registry record updated Feb 14, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
10818 Issued in WI
Practice address
1405 Mill St
New London, WI 54961-2155
Phone
(920) 531-2400
Fax
(920) 531-2450
NPI assigned
Mar 26, 2021
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 14, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 10818-33 WI
Family Nurse Practitioner 363LF0000X 10818 WI Primary

Addresses

Primary practice location

1405 Mill St
New London, WI 54961-2155

Mailing address

96 N Clinton Ave
Clintonville, WI 54929-1250
Phone (715) 460-0347

Other practice location 1

600 N Koeller St
Oshkosh, WI 54902-3241
Phone (920) 385-6612

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jeffrey.fillmore@thedacare.org Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210603001325 WI Practitioner - Nurse Practitioner 7315346889 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Thedacare, IncorporatedGroup PAC ID 1759294887, 654 clinicians

Practice addresses (Care Compare)

1405 Mill St
New London, WI 54961-2155
Phone (920) 831-5050

Hospital & facility affiliations

  • Thedacare at Home Hospice, Appleton, WI, CCN 521504
  • Thedacare Medical Center - New London Hospital, New London, WI, CCN 521326
  • Thedacare Medical Center-Waupaca Hospital, Waupaca, WI, CCN 521334
  • Thedacare Regional Med Ctr - Neenah Hospital, Neenah, WI, CCN 520045
  • Thedacare Regional Medical Center - Appleton Inc Hospital, Appleton, WI, CCN 520160

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
10818WIMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Thedacare, Incorporated CurrentSince Feb 1, 2022 Accepting new patients
Thedacare Medical Center - Berlin, Inc. Past Accepting new patients

Locations

4480 W Spencer St
Appleton, WI 54914
Phone (920) 738-4800

3 Neenah Ctr
Neenah, WI 54956
Phone (920) 454-4229

1405 Mill St
New London, WI 54961
Phone (920) 531-2000

206 S Mill St
Weyauwega, WI 54983
Phone (414) 867-3141

Interoperability endpoints

  • Direct secure messaging: jfillmore304636@direct.thedacare.org

Organizations & group practices 2

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 17

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

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1616716800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1644796800000",
    "number": "1992382873",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "96 N CLINTON AVE",
            "city": "CLINTONVILLE",
            "state": "WI",
            "postal_code": "549291250",
            "telephone_number": "715-460-0347"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1405 MILL ST",
            "city": "NEW LONDON",
            "state": "WI",
            "postal_code": "549612155",
            "telephone_number": "920-531-2400",
            "fax_number": "920-531-2450"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "600 N Koeller St",
            "address_purpose": "LOCATION",
            "city": "Oshkosh",
            "state": "WI",
            "postal_code": "549023241",
            "country_code": "US",
            "telephone_number": "920-385-6612",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FILLMORE",
        "first_name": "JEFFREY",
        "middle_name": "ALLEN",
        "credential": "APNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-03-26",
        "last_updated": "2022-02-14",
        "certification_date": "2022-02-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "WI",
            "license": "10818-33",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "WI",
            "license": "10818",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jeffrey.fillmore@thedacare.org",
            "affiliation": "N",
            "endpointDescription": "work email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1405 Mill St",
            "city": "New London",
            "state": "WI",
            "country_code": "US",
            "postal_code": "549612155",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in New London, WI

Sources for this page

Verify at the official NPI Registry.