Oral and Maxillofacial Surgery Asso of Eau Claire SC

Primary specialty

Oral & Maxillofacial Surgery (D.M.D.)Taxonomy code 204E00000X

License

4495-015 Issued in WI

Legal business name

ORAL AND MAXILLOFACIAL SURGERY ASSO OF EAU CLAIRE SC

Practice address

788 Oakleaf Way
Altoona, WI 54720

Phone

(715) 834-8414

Fax

(715) 834-3557

NPI assigned

Aug 3, 2006

Organization subpart

No

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

Authorized official

Name

Gina K Thor

Title

Transcription and Credentialing

Phone

(715) 834-8414

Specialties & licenses 8

Addresses

Other names 1

• Oral and Maxillofacial Surgery Associates of Eau Claire SC Former legal business name

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

Locations

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Slavko Ivankovic, D.D.S.

  • Oral and Maxillofacial Surgery (Dentist)
  • Altoona, WI
  • NPI 1639241342
  Medicare reassignment Care Compare group NPD
• M. Drew Millington, D.D.S.

  • Oral and Maxillofacial Surgery (Dentist)
  • Altoona, WI
  • NPI 1205908936
  Medicare reassignment Care Compare group NPD
• William Arthur Grosdidier

  • Oral and Maxillofacial Surgery (Dentist)
  • Jbsa Lackland, TX
  • NPI 1447605886

  WI

  Medicare reassignment Care Compare group NPD
• Lulu Fang Schaefer, DDS

  • Student in an Organized Health Care Education/Training Program
  • Altoona, WI
  • NPI 1710319744

  Endodontics

  NPD
• Jeff Jones, D.D.S.

  • Oral and Maxillofacial Surgery (Dentist)
  • Eau Claire, WI
  • NPI 1952473712
  NPD (past)

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

{
    "created_epoch": "1154563200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1532563200000",
    "number": "1316954928",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1120 OAK RIDGE DRIVE",
            "city": "EAU CLAIRE",
            "state": "WI",
            "postal_code": "54701",
            "telephone_number": "715-834-8414",
            "fax_number": "715-834-3557"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "788 OAKLEAF WAY",
            "city": "ALTOONA",
            "state": "WI",
            "postal_code": "54720",
            "telephone_number": "715-834-8414",
            "fax_number": "715-834-3557"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ORAL AND MAXILLOFACIAL SURGERY ASSO OF EAU CLAIRE SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-03",
        "last_updated": "2018-07-26",
        "status": "A",
        "authorized_official_last_name": "THOR",
        "authorized_official_first_name": "GINA",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "TRANSCRIPTION AND CREDENTIALING",
        "authorized_official_telephone_number": "715-834-8414"
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Endodontics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223E0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Endodontics",
            "state": "WI",
            "license": "6222-15",
            "primary": false
        },
        {
            "code": "1223E0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Endodontics",
            "state": "WI",
            "license": "4412-015",
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "204E00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "WI",
            "license": "4495-015",
            "primary": true
        },
        {
            "code": "204E00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "WI",
            "license": "4680-015",
            "primary": false
        },
        {
            "code": "204E00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "WI",
            "license": "5112-015",
            "primary": false
        },
        {
            "code": "204E00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "WI",
            "license": "5563-015",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Oral and Maxillofacial Surgery Associates of Eau Claire SC",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Oral and Maxillofacial Surgery Associates of Eau Claire SC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Oak Leaf Surgical Hospital LLC
• Oak Leaf Surgical Hospital, LLC
• Ashley A Obrien, PA
• Karen Narcelles Oemig, PT
• Connor Gustav Olson, PA-C, LAT, ATC
• Gina L. Ostrowski, PT
• Jose Abran Padilla, M.D.
• John Mathew Pakan, D.C.
• Jody Rae Patscot, PTA
• Katherine M Paulsen, MPAS, PA-C

• Oral & Maxillofacial Surgery (D.M.D.) in Altoona, WI
• Providers in Altoona, WI by specialty
• Oral & Maxillofacial Surgery (D.M.D.) in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.