JACK ANDERSON (NPI# 1992737522) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1992737522 |
| Entity Type | Individual |
| Full Name | JACK ANDERSON |
| Credential | MD |
| Practice Address |
2500 E Capitol Dr Appleton WI 54911-8735 |
| Mailing Address |
Po Box 8003 Appleton WI 54912-8003 |
| Practice Telephone | 9207315811 |
| Practice Fax Number | 9207386293 |
| Mailing Telephone | 9209963298 |
| Enumeration Date | 2006-07-06 |
| Last Update Date | 2011-11-16 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207R00000X | Internal Medicine | 26238-020 | WI | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| RR MEDICARE | 110048483 | 01 | |
| WI | MEDICARE PTAN | 450030618 | 01 |
| WI | 30608500 | 05 | |
| WI | MEDICARE PTAN | 711290042 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982254603 | Jack Anderson | Technician | 14810 La Mesa Rd, Victorville, CA 92392-8639 | 2019-09-14 |
| 1154523470 | Jack Anderson | Chiropractor | 226 E 29th St Unit B, Loveland, CO 80538-2825 | 2007-05-31 |
| 1659338887 | Jack Anderson | Emergency Medicine | 9787 N 91st St Ste 101, Scottsdale, AZ 85258-5088 | 2006-05-01 |
| 1881166775 | Jack Raymond Anderson | Surgery | 1730 W 25th St, Cleveland, OH 44113-3108 | 2018-12-18 |
| 1245527969 | Jack D Anderson | Family Medicine | 1515 Edmonton Rd, Tompkinsville, KY 42167-9402 | 2011-07-01 |
| 1134330947 | Jack Glenn Anderson | Psychologist | 200 E Del Mar Blvd, Suite 122, Pasadena, CA 91105-2544 | 2007-05-24 |
| 1609948223 | Jack Martin Anderson | Pediatrics | 3003 Health Center Dr, San Diego, CA 92123-2700 | 2006-11-15 |
| 1417976234 | Jack D Anderson | Pediatrics | 7030 Pineville Matthews Rd, Charlotte, NC 28226-8298 | 2006-07-19 |
| 1811964000 | Jack W. Anderson | Anesthesiology | 470 Taylor Rd, Montgomery, AL 36117-3563 | 2006-03-07 |
| Street Address |
2500 E CAPITOL DR |
| City | APPLETON |
| State | WI |
| Zip Code | 54911-8735 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053317594 | Deborah A Ihde | Internal Medicine | 2500 E Capitol Dr, Appleton, WI 54911-8735 | 2005-06-21 |
| 1053918524 | Nicole Anne Vannoie | Nurse Practitioner | 2500 E Capitol Dr, Appleton, WI 54911-8735 | 2020-10-07 |
| 1902413081 | Miranda Wendricks | Nurse Practitioner | 2500 E Capitol Dr, Appleton, WI 54911-8735 | 2020-09-23 |
| 1093327694 | Sithichok Chang | Pharmacist | 2500 E Capitol Dr, Appleton, WI 54911-8735 | 2020-08-17 |
| 1073130308 | Elizabeth A Coenen | Registered Nurse | 2500 E Capitol Dr, Appleton, WI 54911-8735 | 2020-07-02 |
| 1386261618 | Abbey M Buchberger | Registered Nurse | 2500 E Capitol Dr, Appleton, WI 54911-8735 | 2020-07-02 |
| 1194342709 | Anna Jane Gauthier | Registered Nurse | 2500 E Capitol Dr, Appleton, WI 54911-8735 | 2020-06-30 |
| 1326665134 | Jessica Marie Schnell | Registered Nurse | 2500 E Capitol Dr, Appleton, WI 54911-8735 | 2020-06-26 |
| 1548886567 | Dana S Lehrer | Nurse Practitioner | 2500 E Capitol Dr, Appleton, WI 54911-8735 | 2020-06-25 |
| 1124644935 | Amy Beth Felberg | Nurse Practitioner | 2500 E Capitol Dr, Appleton, WI 54911-8735 | 2020-06-18 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912545633 | Brotherly Love, LLC | Day Training, Developmentally Disabled Services | 1513 E Frances St, Appleton, WI 54911 | 2019-12-12 |
| 1952952129 | Eagle Point Senior Living Inc | Assisted Living Facility | 995 East John Street, Appleton, WI 54911 | 2019-09-27 |
| 1619524766 | University Rx LLC | Pharmacy | 133 E College Ave, Appleton, WI 54911 | 2019-08-23 |
| 1174080063 | Shayla Russell | Counselor | Outagamie County Health and Human Services, 320 S. Walnut St., Appleton, WI 54911 | 2019-02-27 |
| 1871086645 | Megan Kilsdonk | Health Educator | 1604 N Meade St, Appleton, WI 54911 | 2018-06-07 |
| 1871085480 | Tanya Lynn Vickery | Social Worker | 410 S. Elm St., Appleton, WI 54911 | 2018-05-31 |
| 1013407501 | Teri G Metropulos | Counselor | 229 S. Morrison, Appleton, WI 54911 | 2018-05-10 |
| 1093211211 | Bonnie Anne Korytkowski | Student in an Organized Health Care Education/Training Program | 229 S. Morrison Street, Appleton, WI 54911 | 2018-04-05 |
| 1639673940 | Brett Follett | Psychologist | 401 S. Elm St., Appleton, WI 54911 | 2018-03-21 |
| 1700202892 | Brian Withrow | Counselor | 607 West 7th St., Appleton, WI 54911 | 2014-03-13 |
| Find all providers in zip 54911 | ||||
| Taxonomy Code | 207R00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740654862 | Andrew Pfaffenbach | Internal Medicine | 2693 W Grand Chute Blvd, Appleton, WI 54913-9617 | 2015-12-01 |
| 1235478538 | Arun Cherian | Internal Medicine | 1620 N Mccarthy Rd, Apt # 1, Appleton, WI 54913-8250 | 2013-02-06 |
| 1356589253 | Harold G Danford | Internal Medicine | 1215 Briarcliff Drive, Appleton, WI 54915-2846 | 2009-01-30 |
| 1154593267 | John Edward Kirkpatrick | Internal Medicine | 4321 N Ballard Rd, Appleton, WI 54919-0001 | 2008-03-28 |
| 1386864254 | Hany L Elkaramany | Internal Medicine | 445 S Munsterman St, Appleton, MN 56208-2608 | 2007-04-26 |
| 1679666952 | Joan M Crennan | Internal Medicine | 1665 N Mccarthy Rd Apt 10, Appleton, WI 54913-5458 | 2006-10-01 |
| 1821011651 | Daniel Stephen Mihalo | Internal Medicine | 1526 N Division St, Appleton, WI 54911-3562 | 2006-07-25 |
| 1235181611 | Lowell Frank Peterson | Internal Medicine | 2627 Beechwood Court, Appleton, WI 54911 | 2006-05-16 |
| 1780675439 | Abdur R Khan | Internal Medicine | 1818 N Meade St Ste 130, Appleton, WI 54911 | 2005-11-02 |
| 1588658595 | Ronald T Schreiber | Internal Medicine | 2600 S Heritage Woods Dr, Appleton, WI 54915-1408 | 2005-09-06 |
| Find all providers in APPLETON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.