NPIMap

Individual provider Active NPI

Sarah C Durst, MD

  • Family Medicine Physician
  • Waupaca, WI
National Provider Identifier
1114967312
Registry record updated Mar 11, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
49594 Issued in WI
Practice address
710 Riverside Dr
Waupaca, WI 54981-1941
Phone
(715) 258-1160
Fax
(915) 756-3079
NPI assigned
Jun 7, 2006
Last updated
Mar 11, 2016By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 11, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 49594 WI Primary

Addresses

Primary practice location

710 Riverside Dr
Waupaca, WI 54981-1941

Mailing address

PO Box 8003
Appleton, WI 54912-8003
Phone (920) 996-3264

Other identifiers 1

IdentifierTypeStateIssuer
K400192872OtherWIMEDICARE PTAN

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
I20090929000187 WI Practitioner - Family Practice 7517030232 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Wisconsin School of Medicine, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Thedacare, IncorporatedGroup PAC ID 1759294887, 654 clinicians

Practice addresses (Care Compare)

710 Riverside Dr
Waupaca, WI 54981-1941
Phone (715) 256-3000

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
49594WIMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Thedacare, Incorporated Family Medicine CurrentSince Oct 1, 2009 Accepting new patients
Thedacare Medical Center - Shawano, Inc. Past Accepting new patients

Locations

122 E College Ave
Appleton, WI 54911
Phone (920) 996-3264

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

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

710 Riverside Dr
Waupaca, WI 54981
Phone (715) 256-3000

Interoperability endpoints

  • Direct secure messaging: sdurst24041@direct.thedacare.org

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 17

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

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1149638400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1457654400000",
    "number": "1114967312",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 8003",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549128003",
            "telephone_number": "920-996-3264",
            "fax_number": "920-738-5787"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "710 RIVERSIDE DR",
            "city": "WAUPACA",
            "state": "WI",
            "postal_code": "549811941",
            "telephone_number": "715-258-1160",
            "fax_number": "915-756-3079"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DURST",
        "first_name": "SARAH",
        "middle_name": "C",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-07",
        "last_updated": "2016-03-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "49594",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "K400192872",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Waupaca, WI

Sources for this page

Verify at the official NPI Registry.