JESSICA MARIE JANSSEN — NPI 1093631905 (Licensed & Credentialed Advanced Practice Dental Therapist in WINDOM, MN)

CMS-1500 Box 24J / 33a • NPI

1093631905

Type 1 Individual Rendering/Ordering

HIPAA NUCC Taxonomy • CMS Code

125K00000X

Licensed & Credentialed Advanced Practice Dental Therapist

Box 32 Service Location & ZIP+4

820 2ND AVE N STE 2, WINDOM, MN, 56101-1766

✓ 9-Digit EDI 837 ZIP+4 (56101-1766)

Practice Phone & Referral Fax

(507) 831-3717

Direct NPPES Verification Line

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1093631905 (JESSICA MARIE JANSSEN) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

This practitioner does not currently appear in the CMS individual Order & Referring PECOS file (may practice in pediatrics, commercial-only networks, or hospital-employed settings).

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1093631905` (NPI-1 Individual Practitioner)
Provider / Legal Name	JESSICA MARIE JANSSEN
Plain-English Specialty	Licensed & Credentialed Advanced Practice Dental Therapist NUCC Code: `125K00000X` (Advanced Practice Dental Therapist)
Certifying / Licensing Body	State Medical / Healthcare Licensing Board & National Specialty Board
Practice Location Address	820 2ND AVE N STE 2, WINDOM, MN, 56101-1766
Practice Telephone / Fax	Tel: (507) 831-3717
Administrative Mailing Address	236 LAKE AVE, WORTHINGTON, MN, 56187-1527
Enumeration & Last Sync	Enumerated: 2026-06-25 \| CMS Record Updated: 2026-06-25

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

820 2ND AVE N STE 2, WINDOM, MN, 56101-1766

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Plain-English Taxonomy & CMS Crosswalk (125K00000X)

What Does Taxonomy Code 125K00000X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 125K00000X translates to:
"Licensed & Credentialed Advanced Practice Dental Therapist"

CMS-1500 Medicare Specialty Crosswalk: Standard HIPAA X12N 837P / CMS-1500
Certifying / Accrediting Authority: State Medical / Healthcare Licensing Board & National Specialty Board
Clinical Scope: Consult a verified Advanced Practice Dental Therapist for specialized diagnostic evaluation, treatment planning, and continuity of care.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (JESSICA MARIE JANSSEN)

Typical CPT / Diagnostic Procedures:

Comprehensive Outpatient & Inpatient Clinical Evaluation (CPT 99202–99215)
Diagnostic Workup, Laboratory Ordering & Evidence-Based Care Coordination
Preventive Screening, Patient Counseling & Multidisciplinary Referral

Common Therapeutic Classes:

Evidence-Based Specialty Pharmacotherapy & Preventive Regimens (CMS Part D Standard)

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`125K00000X` — Advanced Practice Dental Therapist Plain English: Licensed & Credentialed Advanced Practice Dental Therapist	State: MN \| License: `DT168` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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JESSICA MARIE JANSSEN (NPI #1093631905)