Active NPI
Thaddeus J Krolicki, M.D.
- Ophthalmology Physician
- Wausau, WI
National Provider Identifier
1053394874
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Ophthalmology Physician
- License
- 41219
- Practice address
- 800 N 1St St
Wausau, WI 54403-4754 - Phone
- (715) 261-8500
- Fax
- (715) 261-8667
- NPI assigned
- Nov 25, 2005
- Last updated
- Oct 7, 2020
- 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 |
|---|---|---|---|---|
| Ophthalmology Physician | 207W00000X | 41219 | WI | Primary |
Addresses
Primary practice location
800 N 1St St
Wausau, WI 54403-4754
Mailing address
800 N 1St St
Wausau, WI 54403-4754
Phone (715) 261-8500
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 32563700 | Medicaid | WI | |
| 002039155 | Other | WI | MEDICARE |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | tkrolicki@directaddress.net |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 41219 | WI | MD | Ophthalmology Physician |
Interoperability endpoints
- tkrolicki@directaddress.net
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1132876800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1602028800000",
"number": "1053394874",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "800 N 1ST ST",
"city": "WAUSAU",
"state": "WI",
"postal_code": "544034754",
"telephone_number": "715-261-8500",
"fax_number": "715-261-8667"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "800 N 1ST ST",
"city": "WAUSAU",
"state": "WI",
"postal_code": "544034754",
"telephone_number": "715-261-8500",
"fax_number": "715-261-8667"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KROLICKI",
"first_name": "THADDEUS",
"middle_name": "J",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-11-25",
"last_updated": "2020-10-07",
"certification_date": "2020-10-07",
"status": "A"
},
"taxonomies": [
{
"code": "207W00000X",
"taxonomy_group": "",
"desc": "Ophthalmology",
"state": "WI",
"license": "41219",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "32563700",
"state": "WI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE",
"identifier": "002039155",
"state": "WI"
}
],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "tkrolicki@directaddress.net",
"affiliation": "N",
"address_1": "800 N 1st St",
"city": "Wausau",
"state": "WI",
"country_code": "US",
"postal_code": "544034754",
"country_name": "United States",
"address_type": "DOM"
}
],
"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 Oct 7, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.