Individual provider Active NPI

Stephan W. Eiler, D.D.S.

  • General Practice Dentistry
  • Ripon, WI
National Provider Identifier
1184717258
Registry record updated Apr 22, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
3668 Issued in WI
Practice address
644 W Oshkosh St
Ripon, WI 54971-1001
Phone
(920) 748-6122
Fax
(920) 748-6070
NPI assigned
Oct 2, 2006
Last updated
Apr 22, 2008By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 22, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 3668 WI Primary

Addresses

Primary practice location

644 W Oshkosh St
Ripon, WI 54971-1001

Mailing address

PO Box 510
Ripon, WI 54971-0510
Phone (920) 748-6122

Other identifiers 1

IdentifierTypeStateIssuer
33711300MedicaidWI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150424002270 WI Order and Referring Only - Oral SurgeryPractitioner - Oral Surgery 6507185550

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
3668WIMDCounseling Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Hillside Dental Associates General Practice 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1159747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1208822400000",
    "number": "1184717258",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 510",
            "city": "RIPON",
            "state": "WI",
            "postal_code": "549710510",
            "telephone_number": "920-748-6122"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "644 W OSHKOSH ST",
            "city": "RIPON",
            "state": "WI",
            "postal_code": "549711001",
            "telephone_number": "920-748-6122",
            "fax_number": "920-748-6070"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EILER",
        "first_name": "STEPHAN",
        "middle_name": "W.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-02",
        "last_updated": "2008-04-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WI",
            "license": "3668",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "33711300",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ripon, WI

Sources for this page

Verify at the official NPI Registry.