Provider Demographics
NPI:1316094931
Name:WELCH, JASON D (MD)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:D
Last Name:WELCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 MINERAL POINT AVE
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53548-2940
Mailing Address - Country:US
Mailing Address - Phone:608-756-6000
Mailing Address - Fax:608-756-6236
Practice Address - Street 1:1000 MINERAL POINT AVE
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53548-2940
Practice Address - Country:US
Practice Address - Phone:608-756-6000
Practice Address - Fax:608-756-6236
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI47491207Q00000X
WI47491-20208M00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1316094931Medicaid
WIWELCHJASOtherMERCYCARE INSURANCE
WI1316094931OtherBCBSWI
WI34605700Medicaid
WIP00943634DB7792OtherRR MEDICARE
WIWELCHJASOtherMERCYCARE INSURANCE
WIP00943634DB7792OtherRR MEDICARE
WIWELCHJASOtherMERCYCARE INSURANCE
WI036454176Medicare PIN