Jennifer R Gruba, PHD is a medicare enrolled "Psychologist - Clinical" provider in Portage, Wisconsin. Her current practice location is
2901 Hunters Trl, Portage, Wisconsin. You can reach out to her office (for appointments etc.) via phone at
(608) 742-5518.
Jennifer R Gruba is licensed to practice in Wisconsin (license number 5149-057) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1033413646.
Healthcare Provider's Profile
| Full Name | Jennifer R Gruba |
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| Gender | Female |
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| Speciality | Psychologist - Clinical |
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| Location | 2901 Hunters Trl, Portage, Wisconsin |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1033413646
- Provider Enumeration Date: 12/23/2010
- Last Update Date: 01/02/2024
Medicare PECOS Information:
- PECOS PAC ID: 3971953597
- Enrollment ID: I20231222001388
Medical Identifiers
Medical identifiers for Jennifer R Gruba such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1033413646 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 106H00000X | Marriage & Family Therapist | 867-124 (Wisconsin) | Secondary |
| 103TC0700X | Psychologist - Clinical | 5149-057 (Wisconsin) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Jennifer R Gruba allows following entities to bill medicare on her behalf.
| Entity Name | Community Service Associates, Sc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1780610923
PECOS PAC ID: 8426948746
Enrollment ID: O20040318001251 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Jennifer R Gruba is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
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Jennifer R Gruba, PHD
710 N. Webb Ave,
Reedsburg, WI 53959
Ph: (608) 524-5151 | Jennifer R Gruba, PHD
2901 Hunters Trl,
Portage, WI 53901-3403
Ph: (608) 742-5518 |
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