NPIMap

Individual provider Active NPI

Mac Roman Weninger, MD

  • Physical Medicine & Rehabilitation Physician
  • Appleton, WI
National Provider Identifier
1114422359
Registry record updated Sep 28, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
License
76726 Issued in WI
Practice address
2400 E Capitol Dr
Appleton, WI 54911-8728
Phone
(920) 731-4101
NPI assigned
Mar 29, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 28, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Medicine & Rehabilitation Physician 208100000X 9409514 KS
Sports Medicine (Physical Medicine & Rehabilitation) Physician 2081S0010X 76726 WI
Physical Medicine & Rehabilitation Physician 208100000X 76726 WI Primary

Addresses

Primary practice location

2400 E Capitol Dr
Appleton, WI 54911-8728

Mailing address

2400 E Capitol Dr
Appleton, WI 54911-8728
Phone (920) 731-4101

Other practice location 1

3901 Rainbow Blvd # MS 1046
Kansas City, KS 66160-8500
Phone (913) 588-6777

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220707003724 WI Practitioner - Physical Medicine and Rehabilitation 5395094098 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Medicine and Rehabilitation
Education
Milwaukee Medical College, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Thedacare, IncorporatedGroup PAC ID 1759294887, 654 clinicians

Practice addresses (Care Compare)

2400 E Capitol Dr
Appleton, WI 54911-8728
Phone (920) 831-5050

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
9409514KSMDPhysical Medicine & Rehabilitation Physician
76726WIMDSports Medicine (Physical Medicine & Rehabilitation) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Thedacare, Incorporated CurrentSince Jun 23, 2022 Accepting new patients
Thedacare Regional Medical Center-Neenah, Inc. Past Accepting new patients
Thedacare Medical Center - Berlin, Inc. Past Accepting new patients
Thedacare Medical Center - Shawano, Inc. Past Accepting new patients

Locations

4480 W Spencer St
Appleton, WI 54914
Phone (920) 738-4800

2400 E Capitol Dr
Appleton, WI 54911
Phone (920) 731-4101

1818 N Meade St
Appleton, WI 54911
Phone (920) 731-4101

3 Neenah Ctr
Neenah, WI 54956
Phone (920) 454-4229

130 2nd St
Neenah, WI 54956
Phone (920) 729-2063

1405 Mill St
New London, WI 54961
Phone (920) 531-2000

600 N Westhaven Dr
Oshkosh, WI 54904
Phone (920) 237-5000

100 Cty Road B
Shawano, WI 54166
Phone (715) 524-2161

Interoperability endpoints

  • Direct secure messaging: mweninger324393@direct.thedacare.org

Organizations & group practices 4

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.

Hospital & facility affiliations 15

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1522281600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664323200000",
    "number": "1114422359",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2400 E CAPITOL DR",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549118728",
            "telephone_number": "920-731-4101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2400 E CAPITOL DR",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549118728",
            "telephone_number": "920-731-4101"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3901 Rainbow Blvd # MS 1046",
            "address_purpose": "LOCATION",
            "city": "Kansas City",
            "state": "KS",
            "postal_code": "661608500",
            "country_code": "US",
            "telephone_number": "913-588-6777",
            "fax_number": "913-588-6765",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WENINGER",
        "first_name": "MAC",
        "middle_name": "ROMAN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-03-29",
        "last_updated": "2022-09-28",
        "certification_date": "2022-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "KS",
            "license": "9409514",
            "primary": false
        },
        {
            "code": "2081S0010X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation, Sports Medicine",
            "state": "WI",
            "license": "76726",
            "primary": false
        },
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "WI",
            "license": "76726",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Appleton, WI

Sources for this page

Verify at the official NPI Registry.