Active NPI
Jon Charles Stephenson, MD
- Family Medicine Physician
- Superior, WI
National Provider Identifier
1114978236
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 21317
- Practice address
- 109 N 28TH St E
Superior, WI 54880-6548 - Phone
- (715) 395-3930
- NPI assigned
- May 13, 2006
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 21317 | WI | Primary |
Addresses
Primary practice location
109 N 28TH St E
Superior, WI 54880-6548
Mailing address
109 N 28TH St E
Superior, WI 54880-6548
Phone (715) 395-3930
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)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147478400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1192752000000",
"number": "1114978236",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "109 N 28TH ST E",
"city": "SUPERIOR",
"state": "WI",
"postal_code": "548806548",
"telephone_number": "715-395-3930"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "109 N 28TH ST E",
"city": "SUPERIOR",
"state": "WI",
"postal_code": "548806548",
"telephone_number": "715-395-3930"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STEPHENSON",
"first_name": "JON",
"middle_name": "CHARLES",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-13",
"last_updated": "2007-10-19",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "WI",
"license": "21317",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Superior, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.