Jennifer Takata, D.O.
Individual provider Active NPI Internal Medicine Physician · Salem, WI
NPI 1992724249 · NPPES record last updated Jan 6, 2020
Key facts
- NPI
- 1992724249
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Internal Medicine Physician 207R00000X
- License
- 036101361 (IL)
- Practice address
- 7322 236TH Ave
Salem, WI 53168-9664 - Phone
- (262) 671-7560
- Fax
- (262) 671-7565
- NPI assigned
- Jul 18, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 6
Hospital & facility affiliations 4
Medicare Care Compare profile
- Specialty
- Internal Medicine
- Education
- Other, 1997
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Advantage Physical Therapy and Sports Rehab, LLC
Froedtert South Inc
Practice addresses (Care Compare)
10222 74TH St
Kenosha, WI 53142-6810
Phone (262) 925-5020
5024 Green Bay Rd
Kenosha, WI 53144-1702
Phone (419) 221-6717
7137 236TH Ave
Salem, WI 53168-8975
Phone (262) 925-5060
7322 236TH Ave
Salem, WI 53168-9664
Phone (262) 577-8460
Hospital & facility affiliations
- Preceptor Home Health South
- Froedtert South Inc.
- Ascension All Saints Hospital
- Northshore University Healthsystem - Evanston Hospital
Merit-based Incentive Payment System (MIPS)
- Final score
- 83.15 of 100
- Quality
- 69.39
- Promoting interoperability
- 100
- Improvement activities
- 40
- Cost
- 74.44
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20061228000380 | WI | Practitioner - Internal Medicine | 3375446487 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy, Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036101361 | IL | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Froedtert South, Inc. | Current |
Accepting new patients | |
| Froedtert South, Inc. | Past | Accepting new patients | |
| The Medical College of Wisconsin, Inc. | Internal Medicine | Past | Accepting new patients |
Locations
6308 8th Ave
Kenosha, WI 53143
Phone (262) 653-5300
6308 8th Ave
Ste 2000B
Kenosha, WI 53143
6308 8th Ave
#3030
Kenosha, WI 53143
Phone (262) 656-3600
10256 Old Green Bay Rd
Fl 2
Pleasant Prairie, WI 53158
Phone (262) 551-4200
7322 236th Ave
Salem, WI 53168
Phone (262) 577-8460
Interoperability endpoints
- jtakata346909@direct.froedtert.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 036101361 | IL | Yes |
Addresses
Primary practice location
7322 236TH Ave
Salem, WI 53168-9664
Mailing address
7322 236TH Ave
Salem, WI 53168-9664
Phone (262) 671-7560
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 49552-21 | Other | WI | WI LICENSE |
Other providers in Salem, WI
- SNF Care Inc
- Jeffrey L Sorensen
- Sports Physical Therapy & Rehab Specialist SC
- Stateline Midwives, LLC
- Ashley Swan
- Turning Leaf Acupuncture, LLC
- Michael James Vanlue
- Abbey Terese Vraney
- Walgreen Co
- Christy J Walsh
All providers in Salem, WI · Internal Medicine Physician in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 6, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.