Individual provider Active NPI

Heather Pearson Schmidt, DO

  • Family Medicine Physician
  • Fond Du Lac, WI
National Provider Identifier
1083711071
Registry record updated Dec 16, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
48274-021 Issued in WI
Practice address
421 Camelot Dr
Fond Du Lac, WI 54935-8335
Phone
(920) 926-8500
Fax
(920) 926-8983
NPI assigned
Sep 20, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 16, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 48274-021 WI Primary

Addresses

Primary practice location

421 Camelot Dr
Fond Du Lac, WI 54935-8335

Mailing address

420 E Division St
Fond Du Lac, WI 54935-4560
Phone (920) 926-8340

Other identifiers 2

IdentifierTypeStateIssuer
P00709479OtherWIRAILROAD MEDICARE
43537800MedicaidWI

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address hschmidt330836@direct-ehr-ssmhc.com Direct
FHIR URL https://fhir.ssmhc.com/fhir/api/FHIR/DSTU2/ Other

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20051129000369 WI Practitioner - Family PracticePractitioner - General Practice 9335169994 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Agnesian Healthcare IncGroup PAC ID 1658289624, 392 clinicians

Practice addresses (Care Compare)

420 E Division St
Fond Du Lac, WI 54935-4560
Phone (920) 923-7400

421 Camelot Dr
Fond Du Lac, WI 54935-8335
Phone (920) 926-8616

430 E Division St
Fond Du Lac, WI 54935-4560
Phone (920) 929-2300

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
48274-021WIMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Agnesian Healthcare Inc CurrentSince Dec 8, 2008 Accepting new patients
Agnesian Healthcare, Inc Current Accepting new patients

Locations

420 E Division St
Fond du Lac, WI 54935
Phone (920) 923-7400

912 S Hickory St
Fond du Lac, WI 54935
Phone (920) 929-7480

421 Camelot Dr
Fond du Lac, WI 54935
Phone (920) 923-7940

Organizations & group practices 2

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": "1158710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1608076800000",
    "number": "1083711071",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "420 E DIVISION ST",
            "city": "FOND DU LAC",
            "state": "WI",
            "postal_code": "549354560",
            "telephone_number": "920-926-8340",
            "fax_number": "920-926-8370"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "421 CAMELOT DR",
            "city": "FOND DU LAC",
            "state": "WI",
            "postal_code": "549358335",
            "telephone_number": "920-926-8500",
            "fax_number": "920-926-8983"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SCHMIDT",
        "first_name": "HEATHER",
        "middle_name": "PEARSON",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-20",
        "last_updated": "2020-12-16",
        "certification_date": "2020-12-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "48274-021",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00709479",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "43537800",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "hschmidt330836@direct-ehr-ssmhc.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "hschmidt330836@direct-ehr-ssmhc.com",
            "address_1": "421 Camelot Dr",
            "city": "Fond Du Lac",
            "state": "WI",
            "country_code": "US",
            "postal_code": "549358335",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://fhir.ssmhc.com/fhir/api/FHIR/DSTU2/",
            "affiliation": "N",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "FHIR API",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCD",
            "address_1": "421 Camelot Dr",
            "city": "Fond Du Lac",
            "state": "WI",
            "country_code": "US",
            "postal_code": "549358335",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Fond Du Lac, WI

Sources for this page

Verify at the official NPI Registry.