Active NPI
Mary Jo Freeman, MD
- Internal Medicine Physician
- Wausau, WI
National Provider Identifier
1356369581
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 20821
- Practice address
- 425 Pine Ridge Blvd
Suite 305B
Wausau, WI 54401-4123 - Phone
- (715) 847-2036
- NPI assigned
- Jul 17, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 20821 | WI | Primary |
Addresses
Primary practice location
425 Pine Ridge Blvd
Suite 305B
Wausau, WI 54401-4123
Mailing address
PO Box 8004
Wausau, WI 54402-8004
Phone (715) 847-2304
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 30260300 | Medicaid | WI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20821 | WI | MD | Cardiovascular Disease Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153094400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1247616000000",
"number": "1356369581",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 8004",
"city": "WAUSAU",
"state": "WI",
"postal_code": "544028004",
"telephone_number": "715-847-2304"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "425 PINE RIDGE BLVD",
"address_2": "SUITE 305B",
"city": "WAUSAU",
"state": "WI",
"postal_code": "544014123",
"telephone_number": "715-847-2036"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FREEMAN",
"first_name": "MARY",
"middle_name": "JO",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-07-17",
"last_updated": "2009-07-15",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "WI",
"license": "20821",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "30260300",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Wausau, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.