Active NPI
Scott Alan Anderson, M.D.
- Family Medicine Physician
- Sturgeon Bay, WI
National Provider Identifier
1124042429
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 38394-20
- Practice address
- 1910 Alabama St
Sturgeon Bay, WI 54235-3532 - Phone
- (920) 746-7200
- NPI assigned
- Jul 27, 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 | 38394-20 | WI | Primary |
Addresses
Primary practice location
1910 Alabama St
Sturgeon Bay, WI 54235-3532
Mailing address
1910 Alabama St
Sturgeon Bay, WI 54235-3532
Phone (920) 746-7200
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 38394-20 | Other | WI | WI LICENSE |
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 |
|---|---|---|---|
| 38394-20 | WI | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Prevea Regional Services, Inc. | Family Medicine | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Family Medicine Physician
- Green Bay, WI
- NPI 1194748061
Family Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153958400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1378252800000",
"number": "1124042429",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1910 ALABAMA ST",
"city": "STURGEON BAY",
"state": "WI",
"postal_code": "542353532",
"telephone_number": "920-746-7200"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1910 ALABAMA ST",
"city": "STURGEON BAY",
"state": "WI",
"postal_code": "542353532",
"telephone_number": "920-746-7200"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ANDERSON",
"first_name": "SCOTT",
"middle_name": "ALAN",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-27",
"last_updated": "2013-09-04",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "WI",
"license": "38394-20",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WI LICENSE",
"identifier": "38394-20",
"state": "WI"
}
],
"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 Sep 4, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.