Active NPI
George C Xakellis Jr., M.D.
- Family Medicine Physician
- Tomah, WI
National Provider Identifier
1164418885
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- MD029031E
- Practice address
- 500 East Veteran Street
Tomah, WI 54660-1016 - Phone
- (608) 372-1792
- NPI assigned
- Sep 27, 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | MD029031E | PA | Primary |
| Geriatric Medicine (Family Medicine) Physician | 207QG0300X | MD029031E | PA |
Addresses
Primary practice location
500 East Veteran Street
Tomah, WI 54660-1016
Mailing address
500 East Veteran Street
Tomah, WI 54660-1016
Phone (608) 372-1792
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1738142 | Other | PA | HIGHMARK BLUE SHIELD |
| 50047703 | Other | PA | CAPITAL BLUE CROSS |
| B18104 | Other | PA | HEALTH ASSURANCE |
| 1012794100001 | Medicaid | PA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
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": "1127779200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1364947200000",
"number": "1164418885",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "500 EAST VETERAN STREET",
"city": "TOMAH",
"state": "WI",
"postal_code": "546601016",
"telephone_number": "608-372-1792"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "500 EAST VETERAN STREET",
"city": "TOMAH",
"state": "WI",
"postal_code": "546601016",
"telephone_number": "608-372-1792"
}
],
"practiceLocations": [],
"basic": {
"last_name": "XAKELLIS",
"first_name": "GEORGE",
"middle_name": "C",
"name_suffix": "Jr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-09-27",
"last_updated": "2013-04-03",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "PA",
"license": "MD029031E",
"primary": true
},
{
"code": "207QG0300X",
"taxonomy_group": "",
"desc": "Family Medicine, Geriatric Medicine",
"state": "PA",
"license": "MD029031E",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HIGHMARK BLUE SHIELD",
"identifier": "1738142",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CAPITAL BLUE CROSS",
"identifier": "50047703",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTH ASSURANCE",
"identifier": "B18104",
"state": "PA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1012794100001",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Tomah, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2013; 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.