Phillip Porter, MD

Primary specialty

Neurological Surgery PhysicianTaxonomy code 207T00000X

License

45030 020 Issued in WI

Practice address

1200 Oakleaf Way
Suite a
Altoona, WI 54720-2245

Phone

(715) 832-1400

NPI assigned

Jul 28, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Medical X-Ray Consultants, LTD

  • Vascular & Interventional Radiology Physician
  • Alexandria, MN
  • NPI 1386601383
  NPD (past)
• Medical Xray Consultants, LTD

  • Neurological Surgery Physician
  • Alexandria, MN
  • NPI 1679838023
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1154044800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639699200000",
    "number": "1033123575",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 OAKLEAF WAY",
            "address_2": "SUITE A",
            "city": "ALTOONA",
            "state": "WI",
            "postal_code": "547202245",
            "telephone_number": "715-832-1400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 OAKLEAF WAY",
            "address_2": "SUITE A",
            "city": "ALTOONA",
            "state": "WI",
            "postal_code": "547202245",
            "telephone_number": "715-832-1400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PORTER",
        "first_name": "PHILLIP",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-28",
        "last_updated": "2021-12-17",
        "certification_date": "2021-12-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207T00000X",
            "taxonomy_group": "",
            "desc": "Neurological Surgery",
            "state": "WI",
            "license": "45030 020",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "34275200",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "pjporter@cvosm.gwaydirect.com",
            "affiliation": "N",
            "address_1": "1200 OakLeaf Way",
            "address_2": "Suite A",
            "city": "Altoona",
            "state": "WI",
            "country_code": "US",
            "postal_code": "547202245",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Thomas Robert Pellatt, D.C.
• Lia Pender, FNP
• Rachel Marie Pfeifer, PT, DPT
• Jodi Pinnow, COTA
• Terry Plomedahl, PT
• Prestige Care at Home, LLC
• Ready Ride Taxi
• Benjamin Reich, DPT
• Sarah Beth Reiter
• Stephen J Ridenour, DDS

• Neurological Surgery Physician in Altoona, WI
• Providers in Altoona, WI by specialty
• Neurological Surgery Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.