Active NPI
John Ellsworth Baldwin, RPH
- Pharmacist
- Lake Geneva, WI
National Provider Identifier
1033495080
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 07769-040
- Practice address
- 351 N Edwards Blvd
Lake Geneva, WI 53147-4563 - Phone
- (262) 248-7885
- NPI assigned
- Oct 21, 2011
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 07769-040 | WI | Primary |
Addresses
Primary practice location
351 N Edwards Blvd
Lake Geneva, WI 53147-4563
Mailing address
351 N Edwards Blvd
Lake Geneva, WI 53147-4563
Phone (262) 248-7885
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 07769-040 | WI | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Past | Accepting new patients |
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1319155200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1319155200000",
"number": "1033495080",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "351 N EDWARDS BLVD",
"city": "LAKE GENEVA",
"state": "WI",
"postal_code": "531474563",
"telephone_number": "262-248-7885"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "351 N EDWARDS BLVD",
"city": "LAKE GENEVA",
"state": "WI",
"postal_code": "531474563",
"telephone_number": "262-248-7885"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BALDWIN",
"first_name": "JOHN",
"middle_name": "ELLSWORTH",
"credential": "RPH",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-10-21",
"last_updated": "2011-10-21",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "WI",
"license": "07769-040",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lake Geneva, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.