Fox Valley Dermatology SC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

42905020 Issued in WI

Legal business name

FOX VALLEY DERMATOLOGY SC

Practice address

515 S Washburn St
Suite 204
Oshkosh, WI 54904-7975

Phone

(920) 232-1130

NPI assigned

Jul 28, 2006

Last updated

Aug 22, 2020By 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

Heather Lenz

Title

Office Manager

Phone

(920) 426-2211

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 2

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.

• Shaun P McDonald, MD

  • Dermatology Physician
  • Oshkosh, WI
  • NPI 1669486320
  Medicare reassignment Care Compare group NPD
• Heather Kimbrough McDonald Wetzel, PA-C

  • Physician Assistant
  • Oshkosh, WI
  • NPI 1538815402
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1154044800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1316951213",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3420 JACKSON ST",
            "address_2": "SUITE E",
            "city": "OSHKOSH",
            "state": "WI",
            "postal_code": "549018144",
            "telephone_number": "920-426-2211",
            "fax_number": "920-426-2231"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "515 S WASHBURN ST",
            "address_2": "SUITE 204",
            "city": "OSHKOSH",
            "state": "WI",
            "postal_code": "549047975",
            "telephone_number": "920-232-1130"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOX VALLEY DERMATOLOGY SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-28",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "LENZ",
        "authorized_official_first_name": "HEATHER",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "920-426-2211"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "WI",
            "license": "42905020",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "34045300",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Dylan J Foss, OD
• Erin Lynn Foss, MD
• Fosso Gelhar Chiropractors of the Fox Valley
• Shelda Sue Fosso, DC
• Patricia Fowler
• Fox Valley Hearing Center
• Fox Valley Hematology & Oncology, S.C.
• Fox Valley Hematology and Oncology, S.C.
• Fox Valley Mental Health, L.L.C.
• Fox Valley Physical Therapy & Wellness Clinic, Inc.

• Dermatology Physician in Oshkosh, WI
• Providers in Oshkosh, WI by specialty
• Dermatology Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.