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JOLENE DORN RDN
NPI 1508596495
Dietitian, Registered - Nutrition, Pediatric in Green Bay, WI

Active since June 14, 2022Accepts Medicare Assignment
1860 SHAWANO AVE, GREEN BAY, WI 54303(920) 496-4700 Get Directions Write a Review

NPPES record last updated: October 11, 2022. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Oct 11, 2022, Sep 1, 2022, Aug 15, 2022 (3 updates tracked since 2022).

About Jolene Dorn Rdn NPPES

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

JOLENE DORN RDN (NPI 1508596495) is an individual nutrition, pediatric provider in Green Bay, Wisconsin, licensed in Wisconsin (5012-29) and active in the NPI registry since June 2022. She is a graduate of Other (2021).

NPPES Registry Identity

NPI1508596495
Entity TypeIndividualFemale
Primary Taxonomy133VN1004X
Provider Legal NameJOLENE DORNCredential: RDN
Location Address1860 SHAWANO AVEGreen Bay, WI 54303-2667
Mailing Address1860 Shawano AveGreen Bay, WI 54303-2667 · (920) 496-4700
Phone(920) 496-4700
Sole ProprietorNo
Medical School CMSOtherGraduated 2021
Enumeration DateJune 14, 2022
Last NPPES UpdateOctober 11, 20223 updates tracked since enumeration
NPPES CertifiedOctober 11, 2022
✔ NPI 1508596495 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDietitian, Registered · Nutrition, PediatricDietary & Nutritional Service Providers
Taxonomy Code133VN1004X
Licenses✔ Licensed in WI · 5012-29✔ Licensed in WI · 2717-29
Definition
An individual who is a Board Certified Specialist in Pediatric Nutrition and applies evidence-based nutrition knowledge in providing medical nutrition therapy for pediatric patients. Specialists work directly with healthy and/or ill children (newborn up to 21 years of age) as well as children with special health care needs in a variety of settings (hospitals, community-based and/or family-centered programs, education programs, home, etc.), OR indirectly through management, care coordination, education, quality improvement, or research practice linked specifically to pediatric nutrition.
1860 SHAWANO AVE, Green Bay, WI 54303
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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, Security Health Plan.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Jolene Dorn Rdn 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 ID4587049218
PECOS Enrollment IDI20220916001514

Medicare Billing Reassignments

2

Medicare enrollment records show Jolene Dorn reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

St Vincent Hospital-Hospital Sisters-Third Order Of St Francis
3.8 mi
General Practice
2710 EXECUTIVE DR
Green Bay, WI 54304
  • Reassigned Medicare billing, Wisconsin enrollment
  • 742 clinicians in this Medicare group
NPI 1285613638 (920) 433-8287
St. Nicholas Hospital-Sisters Of The Third Order Of St Francis
56 mi
Internal Medicine
3113 SAEMANN AVE
Sheboygan, WI 53081
  • Reassigned Medicare billing, Wisconsin enrollment
  • 673 clinicians in this Medicare group
NPI 1275799413 (920) 496-4700

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

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.

KADIE RAE BIESE AUD
Audiologist
1860 SHAWANO AVE
GREEN BAY, WI 54303
Brown County (920) 496-4700
MATTHEW JOHN SPRISTER APNP
Nurse Practitioner (Family)
1860 SHAWANO AVE
GREEN BAY, WI 54303
Brown County (920) 496-4700
JOSIE R DOXTATER AU.D.
Audiologist
1860 SHAWANO AVE
GREEN BAY, WI 54303
Brown County (920) 405-1414
TARA LEIGH BENSON APNP
Nurse Practitioner (Family)
1860 SHAWANO AVE
GREEN BAY, WI 54303
Brown County (920) 429-1700
ANN M LAAKE MD
Internal Medicine (Infectious Disease)
1860 SHAWANO AVE
GREEN BAY, WI 54303
Brown County (920) 496-4700
KWABENA OWARE ADU-GYAMFI MD
Internal Medicine (Gastroenterology)
1860 SHAWANO AVE
GREEN BAY, WI 54303
Brown County (920) 496-4700
DR. ALEXANDER C BARR MD
Otolaryngology
1860 SHAWANO AVE
GREEN BAY, WI 54303
Brown County (920) 496-4700
KYLE M ERIKS CLINE NP
Nurse Practitioner (Family)
1860 SHAWANO AVE
GREEN BAY, WI 54303
Brown County (920) 496-4700

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jolene Dorn's NPI number?

The NPI number for Jolene Dorn is 1508596495. It was assigned to this individual provider in the NPPES registry on June 14, 2022.

Where is Jolene Dorn located?

Jolene Dorn practices at 1860 Shawano Ave, Green Bay, WI 54303. The listed phone number is (920) 496-4700.

What is Jolene Dorn's specialty?

The primary specialty registered for this NPI is Dietitian, Registered, specializing in Nutrition, Pediatric, with taxonomy code 133VN1004X.

Is Jolene Dorn enrolled in Medicare?

Yes. Jolene Dorn is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

Which organizations bill Medicare for Jolene Dorn's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Jolene Dorn reassigns Medicare benefits to 2 organizations: St Vincent Hospital-Hospital Sisters-Third Order Of St Francis (Green Bay, WI) and St. Nicholas Hospital-Sisters Of The Third Order Of St Francis (Sheboygan, WI). Each reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Jolene Dorn's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Jolene Dorn accept?

Health plans from Anthem Blue Cross and Blue Shield and Security Health Plan list Jolene Dorn as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Jolene Dorn was last updated on October 11, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 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.