Individual provider Active NPI

Diane L Staudinger, MD

  • Family Medicine Physician
  • Manitowoc, WI
National Provider Identifier
1326155532
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
33432 Issued in WI
Doing business as
Diane La Verne Staudinger
Practice address
3509 Dewey St
Manitowoc, WI 54220
Phone
(920) 686-5731
Fax
(920) 686-5726
NPI assigned
Aug 24, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 33432 WI Primary

Addresses

Primary practice location

3509 Dewey St
Manitowoc, WI 54220

Mailing address

3509 Dewey St
Manitowoc, WI 54220
Phone (920) 686-5731

Other practice location 1

2219 Garfield St
Two Rivers, WI 54241
Phone (920) 793-2281

Other practice location 2

2219 Garfield St
Two Rivers, WI 54241
Phone (920) 793-2281

Other identifiers 1

IdentifierTypeStateIssuer
32004900MedicaidWI

Other names 1

  • Diane La Verne Staudinger Doing business as

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address dstaudinger70701@direct.myadvocateaurora.org Direct
FHIR URL https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20040810000324 WI Practitioner - Emergency MedicinePractitioner - Family Practice 0547232654 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Aurora Medical Group, Inc. Family Medicine Current Accepting new patients
Aurora Medical Group, Inc. CurrentSince Sep 1, 1999 Accepting new patients
Aurora Medical Group, Inc. CurrentSince Sep 1, 1999 Accepting new patients

Locations

2733 S Ridge Rd
Green Bay, WI 54304
Phone (920) 497-6200

601 Reed Ave
Manitowoc, WI 54220
Phone (920) 682-8841

3509 Dewey St
Manitowoc, WI 54220
Phone (920) 686-5731

1020 N 12th St
Milwaukee, WI 53233
Phone (414) 219-3056

108 S 10th Ave
Sturgeon Bay, WI 54235
Phone (920) 746-7955

5000 Memorial Dr
Two Rivers, WI 54241
Phone (920) 794-5000

2219 Garfield St
Two Rivers, WI 54241
Phone (920) 793-2281

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1156377600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1326155532",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3509 DEWEY ST",
            "city": "MANITOWOC",
            "state": "WI",
            "postal_code": "54220",
            "telephone_number": "920-686-5731",
            "fax_number": "920-686-5726"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3509 DEWEY ST",
            "city": "MANITOWOC",
            "state": "WI",
            "postal_code": "54220",
            "telephone_number": "920-686-5731",
            "fax_number": "920-686-5726"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2219 Garfield St",
            "address_purpose": "LOCATION",
            "city": "Two Rivers",
            "state": "WI",
            "postal_code": "54241",
            "country_code": "US",
            "telephone_number": "920-793-2281",
            "fax_number": "920-794-7553",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2219 Garfield St",
            "address_purpose": "LOCATION",
            "city": "Two Rivers",
            "state": "WI",
            "postal_code": "54241",
            "country_code": "US",
            "telephone_number": "920-793-2281",
            "fax_number": "920-794-7553",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "STAUDINGER",
        "first_name": "DIANE",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-24",
        "last_updated": "2023-03-07",
        "certification_date": "2021-11-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "33432",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "32004900",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "dstaudinger70701@direct.myadvocateaurora.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "3509 DEWEY ST",
            "city": "MANITOWOC",
            "state": "WI",
            "country_code": "US",
            "postal_code": "54220",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "3509 DEWEY ST",
            "city": "MANITOWOC",
            "state": "WI",
            "country_code": "US",
            "postal_code": "54220",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "DIANE",
            "last_name": "STAUDINGER",
            "middle_name": "LA VERNE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Manitowoc, WI

Sources for this page

Verify at the official NPI Registry.