Active NPI
Charles R. Alden, M.D.
- Surgery Physician
- Wausau, WI
National Provider Identifier
1043212947
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- 26085
- Practice address
- 2400 Pine Ridge Blvd
Wausau, WI 54401-7803 - Phone
- (715) 847-2022
- Fax
- (715) 847-2775
- NPI assigned
- Aug 11, 2005
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Surgery Physician | 208600000X | 26085 | WI | Primary |
Addresses
Primary practice location
2400 Pine Ridge Blvd
Wausau, WI 54401-7803
Mailing address
4405 N Lakeshore Dr
Wausau, WI 54401-7417
Phone (715) 359-9824
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 30600600 | Medicaid | WI |
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)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1123718400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1201478400000",
"number": "1043212947",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4405 N LAKESHORE DR",
"city": "WAUSAU",
"state": "WI",
"postal_code": "544017417",
"telephone_number": "715-359-9824"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2400 PINE RIDGE BLVD",
"city": "WAUSAU",
"state": "WI",
"postal_code": "544017803",
"telephone_number": "715-847-2022",
"fax_number": "715-847-2775"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ALDEN",
"first_name": "CHARLES",
"middle_name": "R.",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-08-11",
"last_updated": "2008-01-28",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "WI",
"license": "26085",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "30600600",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Wausau, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.