Active NPI
Jeffrey K Chism, DPM
- Podiatrist
- Merrill, WI
National Provider Identifier
1285621730
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Podiatrist
- License
- 748-025
- Practice address
- 410 E 2ND St
Merrill, WI 54452-2319 - Phone
- (715) 536-7444
- Fax
- (715) 536-1547
- NPI assigned
- Sep 30, 2005
- Last updated
- May 1, 2009
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Podiatrist | 213E00000X | 748-025 | WI | Primary |
Addresses
Primary practice location
410 E 2ND St
Merrill, WI 54452-2319
Mailing address
410 E 2ND St
Merrill, WI 54452-2319
Phone (715) 536-7444
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 43223800 | Medicaid | WI | |
| 1285621730 | Other | WI | BLUE CROSS FEDERAL EMPLOYEE PROGRAM |
| 000000485016 | Other | WI | WI BLUE SHIELD |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 748-025 | WI | MD | Podiatrist |
| 748 | WI | MD | Nurse Practitioner |
Interoperability endpoints
- chism.jeffry.001.0490002@jech.meditab.direct-ci.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1128038400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1241136000000",
"number": "1285621730",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "410 E 2ND ST",
"city": "MERRILL",
"state": "WI",
"postal_code": "544522319",
"telephone_number": "715-536-7444",
"fax_number": "715-536-1547"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "410 E 2ND ST",
"city": "MERRILL",
"state": "WI",
"postal_code": "544522319",
"telephone_number": "715-536-7444",
"fax_number": "715-536-1547"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CHISM",
"first_name": "JEFFREY",
"middle_name": "K",
"name_prefix": "Dr.",
"credential": "DPM",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-09-30",
"last_updated": "2009-05-01",
"status": "A"
},
"taxonomies": [
{
"code": "213E00000X",
"taxonomy_group": "",
"desc": "Podiatrist",
"state": "WI",
"license": "748-025",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "43223800",
"state": "WI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS FEDERAL EMPLOYEE PROGRAM",
"identifier": "1285621730",
"state": "WI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WI BLUE SHIELD",
"identifier": "000000485016",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Merrill, WI
- Jenney Caylor, LPC-IT
- Sheila Ann Champion
- Charles a. Sowieja, D.D.S., S.C.
- Charles Royden Staubs, LLC
- Meagan Chasteene, LPC-IT
- County of Lincoln (Lincoln County Health Department)
- County of Lincoln (Pine Crest Nursing Home)
- County of Lincoln (Lincoln County EMS)
- Cpi Merrill LLC (Badger Family Pharmacy Merrill)
- Barbara B Crapster-Pregont, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.