Active NPI
William J Brusky, MD
- Family Medicine Physician
- Fond Du Lac, WI
National Provider Identifier
1124019898
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 19354
- Practice address
- 145 N Main St
Fond Du Lac, WI 54935-3423 - Phone
- (920) 926-8492
- NPI assigned
- Nov 2, 2005
- 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 | 19354 | WI | Primary |
Addresses
Primary practice location
145 N Main St
Fond Du Lac, WI 54935-3423
Mailing address
420 E Division St
Fond Du Lac, WI 54935-4560
Phone (920) 926-8340
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 30342000 | Medicaid | WI | |
| 930061065 | Other | WI | RAILROAD MEDICARE |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 19354 | WI | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1130889600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1456704000000",
"number": "1124019898",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "420 E DIVISION ST",
"city": "FOND DU LAC",
"state": "WI",
"postal_code": "549354560",
"telephone_number": "920-926-8340",
"fax_number": "920-926-8370"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "145 N MAIN ST",
"city": "FOND DU LAC",
"state": "WI",
"postal_code": "549353423",
"telephone_number": "920-926-8492"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRUSKY",
"first_name": "WILLIAM",
"middle_name": "J",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-11-02",
"last_updated": "2016-02-29",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "WI",
"license": "19354",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "30342000",
"state": "WI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "930061065",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fond Du Lac, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 29, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.