JENNA J MULDER
NPI 1053929653
Physician Assistant in Shawano, WI

Q: What is Jenna Mulder's NPI number?

The NPI number for Jenna Mulder is 1053929653. It was assigned to this individual provider in the NPPES registry on July 20, 2020.

Q: What is Jenna Mulder's specialty?

The primary specialty registered for this NPI is Physician Assistant with taxonomy code 363A00000X.

Q: When was this NPI record last updated?

The NPPES record for Jenna Mulder was last updated on March 22, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years 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 July 20, 2020PECOS EnrolledAccepts Medicare Assignment

100 COUNTY ROAD B, SHAWANO, WI 54166(715) 526-2111(715) 526-9366 Get Directions Write a Review

NPPES record last updated: March 22, 2021. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Mar 22, 2021, Jul 20, 2020 (2 updates tracked since 2020).

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About Jenna J Mulder NPPES

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

JENNA J MULDER (NPI 1053929653) is an individual physician assistant in Shawano, Wisconsin, licensed in Wisconsin (5218) and active in the NPI registry since July 2020. She is enrolled in Medicare PECOS, is affiliated with Thedacare Regional Med Ctr - Neenah, and is a graduate of Other (2020).

NPPES Registry Identity

NPI1053929653

Entity TypeIndividualFemale

Primary Taxonomy363A00000X

Provider Legal NameJENNA J MULDER

Location Address100 COUNTY ROAD BShawano, WI 54166-7072

Mailing Address3 Neenah Ctr Fl 5Neenah, WI 54956-3070 · (920) 830-5900 · Fax (920) 830-5910

Phone(715) 526-2111

Fax(715) 526-9366

Sole ProprietorNo

Medical School CMSOtherGraduated 2020

Enumeration DateJuly 20, 2020

Last NPPES UpdateMarch 22, 20212 updates tracked since enumeration

NPPES CertifiedMarch 22, 2021

✔ NPI 1053929653 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyPhysician AssistantPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363A00000X

License✔ Licensed in WI · 5218

Definition

A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.

Also ListedStudent in an Organized Health Care Education/Training ProgramTaxonomy 390200000X

100 COUNTY ROAD B, Shawano, WI 54166

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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Anthem Blue Cross and Blue Shield, Aspirus Health Plan, CareSource (Common Ground Healthcare) and more.Insurance ›

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

Jenna J Mulder 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 ID8123447729

PECOS Enrollment IDI20201001000362

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Hospital Affiliations CMS Care Compare 2

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Thedacare Regional Med Ctr - Neenah

Acute Care Hospitals · Neenah, WI

5/5 CMS rating

OwnershipVoluntary non-profit - Private

CMS Certification Number520045

Location130 2nd StNeenah, WI 54956 · Winnebago County

Emergency services Birthing friendly

Thedacare Regional Medical Center - Appleton Inc

Acute Care Hospitals · Appleton, WI

4/5 CMS rating

OwnershipVoluntary non-profit - Private

CMS Certification Number520160

Location1818 N Meade StAppleton, WI 54911 · Outagamie County

Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 54166 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

$82.92 typical visit price

range $53.90 – $163.24

Typical copayment $20.73 (range $13.47 – $40.81)

Most-billed visit code 99203

Established Patient

$67.37 typical visit price

range $17.40 – $133.76

Typical copayment $16.84 (range $4.35 – $33.44)

Most-billed visit code 99213

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.

SHOPKO STORES OPERATING CO., LLC

Pharmacy (Community/Retail Pharmacy)