Justin Eric Paulson, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

100986-875 Issued in WI

Practice address

970 S Silver Lake St Ste 102
Oconomowoc, WI 53066-3802

Phone

(262) 569-7100

Fax

(262) 567-6295

NPI assigned

Apr 28, 2008

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Credentials

Doctor of Medicine

State licenses

Interoperability endpoints

• Direct secure messaging: jpaulson164532@direct.phci.org

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

{
    "created_epoch": "1209340800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1708646400000",
    "number": "1316112667",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "970 S SILVER LAKE ST STE 102",
            "city": "OCONOMOWOC",
            "state": "WI",
            "postal_code": "530663802",
            "telephone_number": "262-569-7100",
            "fax_number": "262-567-6295"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "970 S SILVER LAKE ST STE 102",
            "city": "OCONOMOWOC",
            "state": "WI",
            "postal_code": "530663802",
            "telephone_number": "262-569-7100",
            "fax_number": "262-567-6295"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PAULSON",
        "first_name": "JUSTIN",
        "middle_name": "ERIC",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-04-28",
        "last_updated": "2024-02-23",
        "certification_date": "2024-02-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0214X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Pulmonology",
            "state": "NC",
            "license": "2011-00770",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "WI",
            "license": "100986-875",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1316112667",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS NC",
            "identifier": "19EX0",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ryan Christian Parys, LPC
• Lauren Paszkiewicz, H.I.S
• Sunny Dineshkumar Patel, PHARMACIST
• Callie Pauc
• Erik George Paulson, RPH
• Jolene Payne, MS, OTR/L
• Holly Pelnar
• Jerald Joseph Pero, RPH
• Sara Persha, LPC
• Marni Persick, CTN

• Pediatrics Physician in Oconomowoc, WI
• Providers in Oconomowoc, WI by specialty
• Pediatrics Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.