Douglas B Moericke, PA

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

492 Issued in WI

Practice address

18601 Lincoln St
Whitehall, WI 54773-8605

Phone

(715) 538-4361

NPI assigned

Jun 13, 2005

Last updated

Mar 19, 2019By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• County of Trempealeau

  dba TCHCC Farnam

  • Mental Illness Community Based Residential Treatment Facility
  • Whitehall, WI
  • NPI 1295783124
  NPD
• Tri-County Memorial Hospital, Inc.

  • Clinic/Center
  • Independence, WI
  • NPI 1073335642
  NPD
• Gundersen Clinic LTD

  • Clinic/Center
  • La Crosse, WI
  • NPI 1851343115
  NPD (past)

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

{
    "created_epoch": "1118620800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1552953600000",
    "number": "1366446841",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18601 LINCOLN ST",
            "city": "WHITEHALL",
            "state": "WI",
            "postal_code": "547738605",
            "telephone_number": "715-538-1712"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18601 LINCOLN ST",
            "city": "WHITEHALL",
            "state": "WI",
            "postal_code": "547738605",
            "telephone_number": "715-538-4361"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOERICKE",
        "first_name": "DOUGLAS",
        "middle_name": "B",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-13",
        "last_updated": "2019-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "WI",
            "license": "492",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kimberley Lenning
• Caitlin Marie Luttropp, PA-C
• Jeffrey J. Matthews, D.D.S.
• Paul Maulucci, NHA
• Julie J Meyers, APNC-APNP
• Kelly Isabel Mohr, P.T.
• Tanya Mudgett, NP
• Mary C Nilsson, MS
• Angel May Olson, OTA
• Tracey Lynn Olson, LMT

• Medical Physician Assistant in Whitehall, WI
• Providers in Whitehall, WI by specialty
• Medical Physician Assistant in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2019; 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.