Active NPI
Fredrick C Austermann, D.D.S
- Pediatric Dentistry
- Cudahy, WI
National Provider Identifier
1093789331
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- 5000496
- Practice address
- 6217 S Packard Ave
Cudahy, WI 53110-3096 - Phone
- (414) 764-5550
- Fax
- (414) 764-8175
- NPI assigned
- Feb 14, 2006
- 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 |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | 5000496 | WI | Primary |
Addresses
Primary practice location
6217 S Packard Ave
Cudahy, WI 53110-3096
Mailing address
6217 S Packard Ave
Cudahy, WI 53110-3096
Phone (414) 764-5550
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 33535800 | 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 |
|---|---|---|---|
| 5000496 | WI | MD | Pediatric Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1139875200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1323129600000",
"number": "1093789331",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6217 S PACKARD AVE",
"city": "CUDAHY",
"state": "WI",
"postal_code": "531103096",
"telephone_number": "414-764-5550",
"fax_number": "414-764-8175"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6217 S PACKARD AVE",
"city": "CUDAHY",
"state": "WI",
"postal_code": "531103096",
"telephone_number": "414-764-5550",
"fax_number": "414-764-8175"
}
],
"practiceLocations": [],
"basic": {
"last_name": "AUSTERMANN",
"first_name": "FREDRICK",
"middle_name": "C",
"name_prefix": "Dr.",
"credential": "D.D.S",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-02-14",
"last_updated": "2011-12-06",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "WI",
"license": "5000496",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "33535800",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Cudahy, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 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.