Active NPI
John E Docter, C.R.N.A.
- Registered Nurse
- Brookfield, WI
National Provider Identifier
1073773404
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- 30408-030
- Practice address
- 19000 W North Ave
Brookfield, WI 53045-4106 - Phone
- (262) 785-2000
- NPI assigned
- Jun 10, 2008
- 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 |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 30408-030 | WI | Primary |
Addresses
Primary practice location
19000 W North Ave
Brookfield, WI 53045-4106
Mailing address
1750 Mirro Dr
Manitowoc, WI 54220-6712
Phone (920) 682-4803
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 43305200 | 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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 30408-030 | WI | MD | Registered Nurse |
| 30408 | WI | MD | Pain Medicine (Anesthesiology) Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Midwest Anesthesia Consultants SC | 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.
-
- Anesthesiology Physician
- Milwaukee, WI
- NPI 1386668564
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1213056000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1213056000000",
"number": "1073773404",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1750 MIRRO DR",
"city": "MANITOWOC",
"state": "WI",
"postal_code": "542206712",
"telephone_number": "920-682-4803"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "19000 W NORTH AVE",
"city": "BROOKFIELD",
"state": "WI",
"postal_code": "530454106",
"telephone_number": "262-785-2000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DOCTER",
"first_name": "JOHN",
"middle_name": "E",
"credential": "C.R.N.A.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-06-10",
"last_updated": "2008-06-10",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "WI",
"license": "30408-030",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "43305200",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Brookfield, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 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.