Individual provider Active NPI

Douglas E Puffer, M.D.

  • Hematology & Oncology Physician
  • Mequon, WI
National Provider Identifier
1366463267
Registry record updated Oct 22, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hematology & Oncology PhysicianTaxonomy code 207RH0003X
License
40365-020 Issued in WI
Practice address
13111 N Port Washington Rd
Mequon, WI 53097-2416
Phone
(262) 243-7454
Fax
(262) 243-7482
NPI assigned
Jul 23, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 22, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Hematology & Oncology Physician 207RH0003X 40365-020 WI Primary

Addresses

Primary practice location

13111 N Port Washington Rd
Mequon, WI 53097-2416

Mailing address

4425 N Port Washington Road
Csmcp Clinic Credentialing
Glendale, WI 53212-1082
Phone (414) 326-2378

Other identifiers 2

IdentifierTypeStateIssuer
PUFFEDOUOtherWIMERCYCARE INSURANCE
34425400MedicaidWI

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
I20070319000336 WI Practitioner - Hematology/OncologyPractitioner - Internal Medicine 0143323840 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Hematology/Oncology
Education
Ohio State University College of Medicine, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Columbia St Marys Hospital Milwaukee IncGroup PAC ID 5890604722, 311 clinicians

Practice addresses (Care Compare)

13111 N Port Washington Rd
Mequon, WI 53097-2416
Phone (262) 243-7300

2301 N Lake Dr
Milwaukee, WI 53211-4508

2323 N Lake Dr
Milwaukee, WI 53211-4508
Phone (414) 585-1000

2350 N Lake Dr
Milwaukee, WI 53211-4528

801 S 70TH St
West Allis, WI 53214-3147
Phone (414) 773-6600

Hospital & facility affiliations

  • Ascension Columbia St Marys Hospital Milwaukee Hospital, Milwaukee, WI, CCN 520051
  • Aurora Medical Center Hospital, Grafton, WI, CCN 520207
  • Ascension SE Wisconsin Hospital Hospital, Milwaukee, WI, CCN 520136
  • Froedtert Memorial Lutheran Hospital Hospital, Milwaukee, WI, CCN 520177
  • Orthopaedic Hospital of Wisconsin Hospital, Glendale, WI, CCN 520194

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
40365-020WIMDHematology & Oncology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Columbia St. Mary'S Hospital Milwaukee Inc CurrentSince Oct 4, 2012 Accepting new patients
Mercy Health System Corporation CurrentSince Oct 18, 2010 Accepting new patients
Columbia St. Mary'S Hospital Milwaukee, Inc CurrentSince Oct 4, 2012 Accepting new patients
Mercy Health System Corporation CurrentSince Oct 18, 2010 Accepting new patients
Columbia St. Mary'S Hospital Milwaukee, Inc Past Accepting new patients
Prohealth Medical Group Inc Hematology & Oncology Past Accepting new patients

Locations

29624 Network Pl
Chicago, IL 60673
Phone (608) 741-7652

2750 Golf Rd
Delafield, WI 53018
Phone (262) 928-4900

N112W15415 Mequon Rd
Germantown, WI 53022
Phone (262) 250-7800

6900 N Port Washington Rd
Glendale, WI 53217
Phone (414) 270-8100

1000 Mineral Point Ave
Janesville, WI 53548
Phone (608) 261-6868

W180N8085 Town Hall Rd
Menomonee Fls, WI 53051
Phone (262) 257-5000

2350 N Lake Dr
Ste 100
Milwaukee, WI 53211
Phone (414) 298-7250

13111 N Port Washington Rd
Thiensville, WI 53097
Phone (262) 243-7300

N14W23900 Stone Ridge Dr
Waukesha, WI 53188
Phone (262) 549-3030

801 S 70th St
West Allis, WI 53214
Phone (414) 773-6600

Organizations & group practices 6

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.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1153612800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1350864000000",
    "number": "1366463267",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4425 N PORT WASHINGTON ROAD",
            "address_2": "CSMCP CLINIC CREDENTIALING",
            "city": "GLENDALE",
            "state": "WI",
            "postal_code": "532121082",
            "telephone_number": "414-326-2378",
            "fax_number": "414-326-2155"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13111 N PORT WASHINGTON RD",
            "city": "MEQUON",
            "state": "WI",
            "postal_code": "530972416",
            "telephone_number": "262-243-7454",
            "fax_number": "262-243-7482"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PUFFER",
        "first_name": "DOUGLAS",
        "middle_name": "E",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-23",
        "last_updated": "2012-10-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RH0003X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "WI",
            "license": "40365-020",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MERCYCARE INSURANCE",
            "identifier": "PUFFEDOU",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "34425400",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mequon, WI

Sources for this page

Verify at the official NPI Registry.