Community Pediatrics SC

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

Legal business name

COMMUNITY PEDIATRICS SC

Practice address

109 Warren St Ste 4
Beaver Dam, WI 53916-3082

Phone

(920) 885-3305

Fax

(920) 885-5506

NPI assigned

May 15, 2007

Last updated

Apr 8, 2010By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Ms. Dorothy Jean Larson

Title

Account Manager

Phone

(920) 885-3305

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

Locations

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jay M Miesfeld, M.D.

  • Pediatrics Physician
  • Beaver Dam, WI
  • NPI 1437354602
  Medicare reassignment NPD
• Laura Jane Lerwick, APNP

  • Pediatric Nurse Practitioner
  • New Berlin, WI
  • NPI 1972755783

  Pediatrics

  NPD
• Brittany N Vanden Heuvel, APNP

  • Pediatric Nurse Practitioner
  • Oshkosh, WI
  • NPI 1881103893

  Pediatrics

  NPD
• Jessica L Miesfeld, M.D.

  • Pediatrics Physician
  • Beaver Dam, WI
  • NPI 1174841076
  NPD (past)
• Laura M Pierre, CPNP

  • Pediatric Nurse Practitioner
  • Appleton, WI
  • NPI 1063878643

  Pediatrics

  NPD (past)
• Kaitlyn N Pufahl, CPNP

  • Pediatric Nurse Practitioner
  • Beaver Dam, WI
  • NPI 1710272778

  Pediatrics

  NPD (past)

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

{
    "created_epoch": "1179187200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1270684800000",
    "number": "1275749566",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "109 WARREN ST STE 4",
            "city": "BEAVER DAM",
            "state": "WI",
            "postal_code": "539163082",
            "telephone_number": "920-885-3305",
            "fax_number": "920-885-5506"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "109 WARREN ST STE 4",
            "city": "BEAVER DAM",
            "state": "WI",
            "postal_code": "539163082",
            "telephone_number": "920-885-3305",
            "fax_number": "920-885-5506"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY PEDIATRICS SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-15",
        "last_updated": "2010-04-08",
        "status": "A",
        "authorized_official_last_name": "LARSON",
        "authorized_official_first_name": "DOROTHY",
        "authorized_official_middle_name": "JEAN",
        "authorized_official_title_or_position": "ACCOUNT MANAGER",
        "authorized_official_telephone_number": "920-885-3305",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• City of Beaver Dam Et Al (Beaver Dam Fire Department)
• Susan Dorsch Clark, OTR
• Richard Clutson, MD
• Edward F Cody, MD
• Robert A Coe, MD
• Daniel Conard
• Consultants Laboratory of Wisconsin, LLC (SSM Health Laboratories)
• Debra Lynn Conway, MS LPC
• Mischa Renee Cordle, APNP
• Laura Ellen Correa, D.O.

• Pediatrics Physician in Beaver Dam, WI
• Providers in Beaver Dam, WI by specialty
• Pediatrics Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.