NPIMap

Individual provider Active NPI

Ryan Popelka

  • Pharmacist
  • Sturgeon Bay, WI
National Provider Identifier
1114527751
Registry record updated Oct 30, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
20037-40 Issued in WI
Practice address
1536 Egg Harbor Rd
Sturgeon Bay, WI 54235-1257
Phone
(920) 746-0412
NPI assigned
Oct 30, 2020
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 30, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 20037-40 WI Primary

Addresses

Primary practice location

1536 Egg Harbor Rd
Sturgeon Bay, WI 54235-1257

Mailing address

1536 Egg Harbor Rd
Sturgeon Bay, WI 54235-1257
Phone (920) 746-0412

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

LicenseStateTypeSpecialty
20037-40WIMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Wal-Mart Stores East, LP PastSince Nov 1, 2020 Accepting new patients
Wal-Mart Stores East LP PastSince Nov 1, 2020 Accepting new patients

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": "1604016000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1604016000000",
    "number": "1114527751",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1536 EGG HARBOR RD",
            "city": "STURGEON BAY",
            "state": "WI",
            "postal_code": "542351257",
            "telephone_number": "920-746-0412"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1536 EGG HARBOR RD",
            "city": "STURGEON BAY",
            "state": "WI",
            "postal_code": "542351257",
            "telephone_number": "920-746-0412"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POPELKA",
        "first_name": "RYAN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-10-30",
        "last_updated": "2020-10-30",
        "certification_date": "2020-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "WI",
            "license": "20037-40",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sturgeon Bay, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2020; 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.