Ross Hazlewood, DO

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

30950-021 Issued in WI

Practice address

340 Enterprise Drive
Markesan, WI 53946

Phone

(920) 398-2321

Fax

(920) 398-2952

NPI assigned

Aug 9, 2005

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 1

Medicare fee-for-service enrollment

Enrolled in WI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

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.

• Thedacare, Incorporated

  • Family Medicine Physician
  • New London, WI
  • NPI 1376656959

  WI

  Medicare reassignment

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

{
    "created_epoch": "1123545600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1414108800000",
    "number": "1316948847",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "340 ENTERPRISE DRIVE",
            "city": "MARKESAN",
            "state": "WI",
            "postal_code": "53946",
            "telephone_number": "920-398-2321",
            "fax_number": "920-398-2952"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "340 ENTERPRISE DRIVE",
            "city": "MARKESAN",
            "state": "WI",
            "postal_code": "53946",
            "telephone_number": "920-398-2321",
            "fax_number": "920-398-2952"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAZLEWOOD",
        "first_name": "ROSS",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-09",
        "last_updated": "2014-10-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "30950-021",
            "primary": true
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "WI",
            "license": "30950-021",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30047100",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Agnesian Healthcare Inc
• Community Health Network
• Consultants Laboratory of Wisconsin, LLC
• Wesley Jeff Elford, PT
• Jorge Andres Hernandez, DDS
• Sherri Mack, PTA
• Markesan District Schools
• Markesan Resident Home Incorporated
• Leesa Ann McShane, A.P.N.P.

• All providers in Markesan, WI
• Family Medicine Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.