JACLYN S BOARDMAN RD
NPI 1053760553
Dietitian, Registered in Madison, WI

Q: What is Jaclyn Boardman's NPI number?

The NPI number for Jaclyn Boardman is 1053760553. It was assigned to this individual provider in the NPPES registry on June 7, 2016. The provider is also known as Jaclyn S Revello.

Q: What is Jaclyn Boardman's specialty?

The primary specialty registered for this NPI is Dietitian, Registered with taxonomy code 133V00000X.

Q: When was this NPI record last updated?

The NPPES record for Jaclyn Boardman was last updated on December 30, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 19 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since June 07, 2016Accepts Medicare Assignment

700 S PARK ST STE A, MADISON, WI 53715(608) 260-2900(608) 260-2977 Get Directions Write a Review

NPPES record last updated: December 30, 2024. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Dec 30, 2024, Nov 23, 2020 (2 updates tracked since 2020).

On this page

About Jaclyn S Boardman Rd NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

JACLYN S BOARDMAN RD (NPI 1053760553) is an individual dietitian, registered in Madison, Wisconsin, licensed in Wisconsin (2911-029) and active in the NPI registry since June 2016. She is a graduate of Other (2006).

NPPES Registry Identity

NPI1053760553

Entity TypeIndividualFemale

Primary Taxonomy133V00000X

Provider Legal NameJACLYN S BOARDMANCredential: RD

Location Address700 S PARK ST STE AMadison, WI 53715-1830

Mailing Address700 S Park St Ste AMadison, WI 53715-1830 · (608) 260-2900 · Fax (608) 260-2977

Phone(608) 260-2900

Fax(608) 260-2977

Sole ProprietorNo

Medical School CMSOtherGraduated 2006

Enumeration DateJune 7, 2016

Last NPPES UpdateDecember 30, 20242 updates tracked since enumeration

NPPES CertifiedDecember 30, 2024

✔ NPI 1053760553 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDietitian, RegisteredDietary & Nutritional Service Providers

Taxonomy Code133V00000X

License✔ Licensed in WI · 2911-029

Definition

A Registered Dietitian (RD)/Registered Dietitian Nutritionist (RDN) is an individual uniquely trained in the science of nutrition and practice of dietetics to design and provide medical nutrition therapy (MNT) and other evidence-based applications of the Nutrition Care Process (NCP) that exemplify the profession's systematic approach to providing high quality nutrition care. Registered dietitians provide MNT for the purpose of disease prevention or management, or to treat or rehabilitate an illness, injury, or condition, with the use of specific, indicated physical and cognitive nutrition care services comprised of one or more of the following aspects of the NCP: nutrition assessment/reassessment, nutrition diagnosis, nutrition intervention (e.g., nutrition counseling, therapeutic diet ordering, and nutrition education) and nutrition monitoring and evaluation.

700 S PARK ST STE A, Madison, WI 53715

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Other Names 1

Former Name (1)Jaclyn S Revello

Other Identifiers 1

Medicaid1053760553WI

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Jaclyn S Boardman Rd is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID7113217647

PECOS Enrollment IDI20160613000141

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 53715 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$0.00 typical visit price

range $53.90 – $163.24

Typical copayment $0.00 (range $13.47 – $40.81)

Most-billed visit code NA

Established Patient

$95.41 typical visit price

range $17.40 – $133.76

Typical copayment $23.85 (range $4.35 – $33.44)

Most-billed visit code 99214

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MR. ARUN X SWAMINATHAN M.B.B.S.

Psychiatry & Neurology (Neurology)