Jack R Meyer, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

27277 Issued in WI

Practice address

200 Patriot Dr
Little Chute, WI 54140-1184

Phone

(920) 687-2800

NPI assigned

Sep 9, 2005

Last updated

Sep 4, 2008By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1126224000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1220486400000",
    "number": "1093709651",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 PATRIOT DR",
            "city": "LITTLE CHUTE",
            "state": "WI",
            "postal_code": "541401184",
            "telephone_number": "920-687-2800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 PATRIOT DR",
            "city": "LITTLE CHUTE",
            "state": "WI",
            "postal_code": "541401184",
            "telephone_number": "920-687-2800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEYER",
        "first_name": "JACK",
        "middle_name": "R",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-09",
        "last_updated": "2008-09-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "27277",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30756500",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Cary Ann Luitjens, PT
• Natalie Lutkowski
• Melinda Marasch, MSW, LCSW
• Elese McClarie, DMD
• Timothy McMahon, LCSW, SAC-IT
• Gary A Miller, R.PH.
• Mindful Matters LLC
• Nicholas L Smith Pharmacy LLC (Smith Pharmacy - LTC)
• Nicholas L Smith Pharmacy LLC (Smith Pharmacy)
• NSH Little Chute LLC (Little Chute Health Services)

• Family Medicine Physician in Little Chute, WI
• Providers in Little Chute, WI by specialty
• Family Medicine Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 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.

Verify at the official NPI Registry.