JENNIFER A PROM (PAC) – Physician Assistant, NPI 1215948781
Physician Assistant
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Doctor Profile
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Profile Insights
NPPES metrics only — not quality of care.
3,678 PHYSICIAN ASSISTANT in WI
Provider Addresses for JENNIFER A PROM (PAC)
109 N 28th St E
Superior, WI 548806548
Phone: (715) 395-3950
Fax: (715) 395-3955
Type: Location
619, West Central Entrance, Duluth, Saint Louis County, Minnesota, 55811, United States
DULUTH, MN 558115448
Phone: (218) 249-4987
Fax: (218) 249-4989
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
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This can happen when there are no reportable CMS Open Payments records.
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: 2019-03-12
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking 2 Medicare enrollment records; no due dates published yet.
Enrollment records
2
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 |
|---|---|---|---|---|
| I20060503000634 | I | Physician Assistant | MN | TBD |
| I20190312003071 | I | Physician Assistant | WI | 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.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 109 | 97 | $0 |
| 99212 | Established patient office or other outpatient visit, 10-19 minutes | 12 | 12 | $0 |
Insurance plans in this area (ZIP 54880)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Certified Registered Nurse Anesthetist (Crna) | MN | |
| - | MN | |
| Vascular Surgery | IL | |
| Physician Assistant | MN | |
| Emergency Medicine | MN | |
| - | MN | |
| Emergency Medicine | MN | |
| - | MN | |
| Physician Assistant | MN | |
| Hematology/Oncology, Internal Medicine | MN |
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