Active NPI
Jeanne T Groos, MD
- Pediatrics Physician
- Stevens Point, WI
National Provider Identifier
1063566099
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 28881
- Practice address
- 824 Illinois Ave
Stevens Point, WI 54481-3112 - Phone
- (715) 342-7500
- NPI assigned
- Jan 23, 2007
- Last updated
- Dec 14, 2011
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 28881 | WI | Primary |
Addresses
Primary practice location
824 Illinois Ave
Stevens Point, WI 54481-3112
Mailing address
824 Illinois Ave
Stevens Point, WI 54481-3112
Phone (715) 342-7500
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 28881 | Other | WI | WI STATE LIC |
| 31367700 | 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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 28881 | WI | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169510400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1323820800000",
"number": "1063566099",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "824 ILLINOIS AVE",
"city": "STEVENS POINT",
"state": "WI",
"postal_code": "544813112",
"telephone_number": "715-342-7500"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "824 ILLINOIS AVE",
"city": "STEVENS POINT",
"state": "WI",
"postal_code": "544813112",
"telephone_number": "715-342-7500"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GROOS",
"first_name": "JEANNE",
"middle_name": "T",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-01-23",
"last_updated": "2011-12-14",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "WI",
"license": "28881",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WI STATE LIC",
"identifier": "28881",
"state": "WI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "31367700",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Stevens Point, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 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.