Active NPI
William Russell Pinkonsly, M.D.
- Emergency Medicine Physician
- Wautoma, WI
National Provider Identifier
1295837797
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Emergency Medicine Physician
- License
- 48295
- Practice address
- N2934 Highway 22
Wautoma, WI 54982 - Phone
- (920) 787-4613
- NPI assigned
- Sep 4, 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 48295 | WI | |
| Emergency Medicine Physician | 207P00000X | 48295 | WI | Primary |
Addresses
Primary practice location
N2934 Highway 22
Wautoma, WI 54982
Mailing address
1300 South Drive
PO Box 0009
Winnebago, WI 54985
Phone (920) 235-4910
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4136296002 | Other | WI | UHC MA DIAMOND PROV # |
| P00252127 | Other | WI | RR MEDICARE PROV # |
| 43523600 | Medicaid | WI | |
| 47763 | Other | WI | NETWORK HEALTH PROV # |
| 48295 | Other | WI | STATE LICENSE # |
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 Osteopathy, Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mercy Medical Center-Centerville | Past | Accepting new patients | |
| Radiology Associates of Appleton, S.C. | Past | Accepting new patients |
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.
-
- Diagnostic Radiology Physician
- Appleton, WI
- NPI 1841229093
-
- Emergency Care Clinic/Center
- Centerville, IA
- NPI 1528018801
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1157328000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1469059200000",
"number": "1295837797",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1300 SOUTH DRIVE",
"address_2": "PO BOX 0009",
"city": "WINNEBAGO",
"state": "WI",
"postal_code": "54985",
"telephone_number": "920-235-4910",
"fax_number": "920-237-2043"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "N2934 HIGHWAY 22",
"city": "WAUTOMA",
"state": "WI",
"postal_code": "54982",
"telephone_number": "920-787-4613"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PINKONSLY",
"first_name": "WILLIAM",
"middle_name": "RUSSELL",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-04",
"last_updated": "2016-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "WI",
"license": "48295",
"primary": false
},
{
"code": "207P00000X",
"taxonomy_group": "",
"desc": "Emergency Medicine",
"state": "WI",
"license": "48295",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UHC MA DIAMOND PROV #",
"identifier": "4136296002",
"state": "WI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MEDICARE PROV #",
"identifier": "P00252127",
"state": "WI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "43523600",
"state": "WI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NETWORK HEALTH PROV #",
"identifier": "47763",
"state": "WI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LICENSE #",
"identifier": "48295",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Wautoma, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.