Individual provider Active NPI

Patrick D Obrien, MD

  • Cardiovascular Disease Physician
  • Appleton, WI
National Provider Identifier
1265427496
Registry record updated Feb 23, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
27747 Issued in WI
Practice address
1506 S Oneida St
Appleton, WI 54915-1305
Phone
(920) 730-6700
NPI assigned
Sep 14, 2005
Last updated
Feb 23, 2010By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 23, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X 27747 WI Primary

Addresses

Primary practice location

1506 S Oneida St
Appleton, WI 54915-1305

Mailing address

1506 S Oneida St
Appleton, WI 54915-1305
Phone (920) 730-6700

Other identifiers 1

IdentifierTypeStateIssuer
31421200MedicaidWI

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
I20040414000891 WI Practitioner - Cardiovascular Disease (Cardiology)Practitioner - Interventional Cardiology 8729072426 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
27747WIMDCardiovascular Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Ascension Calumet Hospital, Inc CurrentSince Feb 22, 2016 Accepting new patients

Locations

1501 S Madison St
Appleton, WI 54915
Phone (920) 730-4435

1506 S Oneida St
Appleton, WI 54915
Phone (920) 730-4950

614 Memorial Dr
Chilton, WI 53014
Phone (800) 458-4042

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": "1126656000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1266883200000",
    "number": "1265427496",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1506 S ONEIDA ST",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549151305",
            "telephone_number": "920-730-6700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1506 S ONEIDA ST",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549151305",
            "telephone_number": "920-730-6700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OBRIEN",
        "first_name": "PATRICK",
        "middle_name": "D",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-14",
        "last_updated": "2010-02-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "WI",
            "license": "27747",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "31421200",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Appleton, WI

Sources for this page

Verify at the official NPI Registry.