NPIMap

Individual provider Active NPI

Taylor B Doberstein, D.O.

  • Rheumatology Physician
  • Neenah, WI
National Provider Identifier
1215291075
Registry record updated Mar 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rheumatology PhysicianTaxonomy code 207RR0500X
License
61412 Issued in WI
Practice address
200 Theda Clark Medical PLZ Ste 240
Neenah, WI 54956-2790
Phone
(920) 831-5050
Fax
(920) 727-4511
NPI assigned
Jun 26, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rheumatology Physician 207RR0500X 61412 WI Primary

Addresses

Primary practice location

200 Theda Clark Medical PLZ Ste 240
Neenah, WI 54956-2790

Mailing address

PO Box 8003
Appleton, WI 54912-8003
Phone (920) 830-5900

Other practice location 1

200 Hawkins Dr
Department of Internal Medicine
Iowa City, IA 52242-1009
Phone (319) 356-1311

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170818000199 WI Practitioner - RheumatologyPractitioner - Internal Medicine 6002047628 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
RheumatologyAlso: Internal Medicine
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Thedacare, IncorporatedGroup PAC ID 1759294887, 654 clinicians

Practice addresses (Care Compare)

200 Theda Clark Medical Plaza
Suite 35
Neenah, WI 54956-2790
Phone (920) 729-2710

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
61412WIMDRheumatology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Thedacare, Incorporated CurrentSince Aug 1, 2017 Accepting new patients
Thedacare Medical Center - Berlin, Inc. Past Accepting new patients

Locations

122 E College Ave
Appleton, WI 54911
Phone (920) 996-3264

4480 W Spencer St
Appleton, WI 54914
Phone (920) 738-4800

200 Theda Clark Medical Plz
Ste 240
Neenah, WI 54956
Phone (920) 725-2070

200 Theda Clark Medical Plz
Ste 350
Neenah, WI 54956
Phone (920) 720-9000

1405 Mill St
New London, WI 54961
Phone (920) 531-2000

600 N Westhaven Dr
Oshkosh, WI 54904
Phone (920) 237-5000

Interoperability endpoints

  • Direct secure messaging: tdoberstein180564@direct.thedacare.org

Organizations & group practices 2

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.

Hospital & facility affiliations 19

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1340668800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1215291075",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 8003",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549128003",
            "telephone_number": "920-830-5900",
            "fax_number": "920-738-5787"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 THEDA CLARK MEDICAL PLZ STE 240",
            "city": "NEENAH",
            "state": "WI",
            "postal_code": "549562790",
            "telephone_number": "920-831-5050",
            "fax_number": "920-727-4511"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "200 Hawkins Dr",
            "address_2": "Department of Internal Medicine",
            "address_purpose": "LOCATION",
            "city": "Iowa City",
            "state": "IA",
            "postal_code": "522421009",
            "country_code": "US",
            "telephone_number": "319-356-1311",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DOBERSTEIN",
        "first_name": "TAYLOR",
        "middle_name": "B",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-06-26",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RR0500X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Rheumatology",
            "state": "WI",
            "license": "61412",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Neenah, WI

Sources for this page

Verify at the official NPI Registry.