Individual provider Active NPI

Katherine L. Simeth, D.D.S.

  • General Practice Dentistry
  • Rice Lake, WI
National Provider Identifier
1104108158
Registry record updated Aug 28, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
6721-15 Issued in WI
Practice address
1501 W Stout St
Rice Lake, WI 54868-5001
Phone
(715) 236-8900
NPI assigned
Sep 15, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 28, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 6721-15 WI Primary

Addresses

Primary practice location

1501 W Stout St
Rice Lake, WI 54868-5001

Mailing address

1000 N Oak Ave
Marshfield, WI 54449-5703
Phone (715) 387-5511

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: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120625000644 WI Order and Referring Only - Oral SurgeryPractitioner - Oral Surgery 2062677073

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

NPI Registry JSON

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

{
    "created_epoch": "1316044800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1377648000000",
    "number": "1104108158",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 N OAK AVE",
            "city": "MARSHFIELD",
            "state": "WI",
            "postal_code": "544495703",
            "telephone_number": "715-387-5511"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1501 W STOUT ST",
            "city": "RICE LAKE",
            "state": "WI",
            "postal_code": "548685001",
            "telephone_number": "715-236-8900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIMETH",
        "first_name": "KATHERINE",
        "middle_name": "L.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-09-15",
        "last_updated": "2013-08-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WI",
            "license": "6721-15",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rice Lake, WI

Sources for this page

Verify at the official NPI Registry.