Tammie J Haveman

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

1306 Issued in MN

Practice address

405 Stageline Rd
Hudson, WI 54016-7848

Phone

(715) 531-6000

NPI assigned

Aug 7, 2009

Last updated

May 13, 2019By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Tammie J Ray Former name

Medicare fee-for-service enrollment

Enrolled in MN, WI2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• Hudson Hospital, Inc.

  dba Hudson Hospital & Clinics

  • Critical Access Hospital
  • Hudson, WI
  • NPI 1396849303
  Medicare reassignment NPD
• Lakeview Memorial Hospital Association Inc.

  • Neonatal Nurse Practitioner
  • Stillwater, MN
  • NPI 1821114729

  Emergency Medicine

  Medicare reassignment NPD
• Hudson Hospital, Inc.

  • Critical Access Hospital
  • Hudson, WI
  • NPI 1255532875
  NPD
• Lakeview Memorial Hospital Association Inc

  dba Lakeview Outpatient Pharmacy

  • Pharmacy
  • Stillwater, MN
  • NPI 1326124454
  NPD
• Stillwater Medical Group

  dba Stillwater Medical Group Mahtomedi

  • Family Medicine Physician
  • Saint Paul, MN
  • NPI 1861742918
  NPD
• Hudson Hospital, Inc

  dba Hudson Hospital & Clinics

  • Clinic/Center
  • Hudson, WI
  • NPI 1184685190
  NPD (past)

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

{
    "created_epoch": "1249603200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1557705600000",
    "number": "1144451139",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6025 LAKE RD",
            "address_2": "SUITE 200",
            "city": "WOODBURY",
            "state": "MN",
            "postal_code": "551251712",
            "telephone_number": "651-999-6800",
            "fax_number": "651-999-6830"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "405 STAGELINE RD",
            "city": "HUDSON",
            "state": "WI",
            "postal_code": "540167848",
            "telephone_number": "715-531-6000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "927 Churchill St W",
            "address_purpose": "LOCATION",
            "city": "Stillwater",
            "state": "MN",
            "postal_code": "550826605",
            "country_code": "US",
            "telephone_number": "651-439-5330",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "6025 Lake Rd",
            "address_2": "Suite 200",
            "address_purpose": "LOCATION",
            "city": "Woodbury",
            "state": "MN",
            "postal_code": "551251712",
            "country_code": "US",
            "telephone_number": "651-999-6800",
            "fax_number": "651-999-6830",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HAVEMAN",
        "first_name": "TAMMIE",
        "middle_name": "J",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-08-07",
        "last_updated": "2019-05-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "1306",
            "primary": true
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "WI",
            "license": "2819-23",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PENDING",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TAMMIE",
            "last_name": "RAY",
            "middle_name": "J",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Reed Harris, HIS
• Sara Martine Harris
• Rebecca Ann Harrison, MD
• Rainyn Hart
• Nicole Haus, DDS
• Lisa Renee Haverly, MA/OT
• Saoirse Nicole Hayes, PHARMD
• Hazelden Betty Ford Foundation (Hazelden Hudson)
• Healthmax Chiropractic of Hudson, LLC
• Heartwood Holistic Counseling

• Physician Assistant in Hudson, WI
• Providers in Hudson, WI by specialty
• Physician Assistant in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.