MRS. JACQUELYN RENE FORSSBERG (APRN) – Pediatric Nurse Practitioner, NPI 1043628233
Pediatric Nurse Practitioner
Main info
Doctor Profile
Contacts
Profile Insights
NPPES metrics only — not quality of care.
3,550 NURSE PRACTITIONER in KS
Provider Addresses for MRS. JACQUELYN RENE FORSSBERG (APRN)
592 TERRACE DR
PRATT, KS 671243213
Phone: (913) 908-5225
Type: Mailing
200 Commodore St
Pratt, KS 671242903
Phone: (620) 450-1186
Fax: (620) 450-1741
Type: Location
1021 EISENHOWER AVE
GREAT BEND, KS 67530
Phone: (620) 792-5437
Type: Location
200 COMMODORE ST
PRATT, KS 671242903
Phone: (620) 450-1186
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 22 Open Payments records for all available years, with a total value of $1,719.
Total Amount is formed as General ($1,719) + Research ($0) + Ownership ($0) = $1,719.
Last reported payment date: 2024-09-11 • Largest payer in this snapshot: Axonics, Inc. ($1,573).
Total Amount
$1,719
General + Research + Ownership
Payments
22
Total payment records
General Amount
$1,719
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-09-11
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Axonics, Inc. | $1,573 |
| Sumitomo Pharma America, Inc. | $56 |
| Organon LLC | $26 |
| PFIZER INC. | $18 |
| Inspire Medical Systems, Inc. | $18 |
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2016-05-10
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20160510002483 | I | Nurse Practitioner | KS | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 67124)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Orthopedic Surgery | KS | |
| Nurse Practitioner | KS | |
| Internal Medicine | KS | |
| Clinical Psychologist | KS | |
| Nurse Practitioner | KS | |
| Physician Assistant | KS | |
| Cardiovascular Disease (Cardiology) | NOT LISTED | |
| Mental Health Counselor | KS | |
| P O D I A T R Y | KS | |
| Nurse Practitioner | KS |
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