Active NPI
R. R. Flickinger Jr., M.D.
- Ophthalmology Physician
- Waukesha, WI
National Provider Identifier
1265498281
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Ophthalmology Physician
- License
- 17452-020
- Practice address
- 1111 Delafield St
Suite 312
Waukesha, WI 53188-3417 - Phone
- (262) 547-3352
- Fax
- (262) 547-9142
- NPI assigned
- Apr 26, 2006
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Ophthalmology Physician | 207W00000X | 17452-020 | WI | Primary |
Addresses
Primary practice location
1111 Delafield St
Suite 312
Waukesha, WI 53188-3417
Mailing address
1111 Delafield St
Suite 312
Waukesha, WI 53188-3417
Phone (262) 547-3352
Other identifiers 8
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 31224700 | Medicaid | WI | |
| 4016118 | Other | WI | AETNA |
| 747042 | Other | WI | MOHAWK |
| 31224700 | Other | WI | MANAGED HEALTH SERVICES |
| 822601 | Other | WI | VIPA |
| 09235 | Other | WI | HEALTH ALLIANCE |
| 31224700 | Other | WI | ABRI |
| 0800073 | Other | WI | UNITED HEALTHCARE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 17452-020 | WI | MD | Ophthalmology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1146009600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1190073600000",
"number": "1265498281",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1111 DELAFIELD ST",
"address_2": "SUITE 312",
"city": "WAUKESHA",
"state": "WI",
"postal_code": "531883417",
"telephone_number": "262-547-3352",
"fax_number": "262-547-9142"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1111 DELAFIELD ST",
"address_2": "SUITE 312",
"city": "WAUKESHA",
"state": "WI",
"postal_code": "531883417",
"telephone_number": "262-547-3352",
"fax_number": "262-547-9142"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FLICKINGER",
"first_name": "R.",
"middle_name": "R.",
"name_suffix": "Jr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-04-26",
"last_updated": "2007-09-18",
"status": "A"
},
"taxonomies": [
{
"code": "207W00000X",
"taxonomy_group": "",
"desc": "Ophthalmology",
"state": "WI",
"license": "17452-020",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "31224700",
"state": "WI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "4016118",
"state": "WI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MOHAWK",
"identifier": "747042",
"state": "WI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MANAGED HEALTH SERVICES",
"identifier": "31224700",
"state": "WI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "VIPA",
"identifier": "822601",
"state": "WI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTH ALLIANCE",
"identifier": "09235",
"state": "WI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ABRI",
"identifier": "31224700",
"state": "WI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED HEALTHCARE",
"identifier": "0800073",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Waukesha, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.