Individual provider Active NPI

John J Nash, M.D.

  • Otolaryngology Physician
  • Fond Du Lac, WI
National Provider Identifier
1225117245
Registry record updated Dec 15, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
50889 Issued in WI
Practice address
421 Camelot Dr
Fond Du Lac, WI 54935-8335
Phone
(920) 926-8460
NPI assigned
Nov 2, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 15, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology Physician 207Y00000X 50889 WI Primary

Addresses

Primary practice location

421 Camelot Dr
Fond Du Lac, WI 54935-8335

Mailing address

420 E Division St
Fond Du Lac, WI 54935-4560
Phone (920) 926-8340

Other identifiers 2

IdentifierTypeStateIssuer
P00983448OtherWIRAILROAD MEDICARE
100016598MedicaidWI

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address jnash331067@direct-ehr-ssmhc.com Direct
FHIR URL https://fhir.ssmhc.com/fhir/api/FHIR/DSTU2/ Other

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: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110817000819 WI Practitioner - Otolaryngology 4284803727 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Otolaryngology
Education
Medical College of Wisconsin, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Agnesian Healthcare IncGroup PAC ID 1658289624, 392 clinicians

Practice addresses (Care Compare)

420 E Division St
Fond Du Lac, WI 54935-4560
Phone (920) 923-7400

421 Camelot Dr
Fond Du Lac, WI 54935-8335
Phone (920) 926-8616

430 E Division St
Fond Du Lac, WI 54935-4560
Phone (920) 929-2300

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
50889WIMDOtolaryngology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Agnesian Healthcare Inc CurrentSince Aug 15, 2011 Accepting new patients
Agnesian Healthcare, Inc Current Accepting new patients

Locations

421 Camelot Dr
Fond du Lac, WI 54935
Phone (920) 923-7940

420 E Division St
Fond du Lac, WI 54935
Phone (920) 923-7400

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 1

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

NPI Registry JSON

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

{
    "created_epoch": "1162425600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1607990400000",
    "number": "1225117245",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "420 E DIVISION ST",
            "city": "FOND DU LAC",
            "state": "WI",
            "postal_code": "549354560",
            "telephone_number": "920-926-8340",
            "fax_number": "920-926-8370"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "421 CAMELOT DR",
            "city": "FOND DU LAC",
            "state": "WI",
            "postal_code": "549358335",
            "telephone_number": "920-926-8460"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NASH",
        "first_name": "JOHN",
        "middle_name": "J",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-02",
        "last_updated": "2020-12-15",
        "certification_date": "2020-12-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "WI",
            "license": "50889",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00983448",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100016598",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jnash331067@direct-ehr-ssmhc.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "jnash331067@direct-ehr-ssmhc.com",
            "address_1": "421 Camelot Dr",
            "city": "Fond Du Lac",
            "state": "WI",
            "country_code": "US",
            "postal_code": "549358335",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://fhir.ssmhc.com/fhir/api/FHIR/DSTU2/",
            "affiliation": "N",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "FHIR API",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCD",
            "address_1": "421 Camelot Dr",
            "city": "Fond Du Lac",
            "state": "WI",
            "country_code": "US",
            "postal_code": "549358335",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Fond Du Lac, WI

Sources for this page

Verify at the official NPI Registry.