Active NPI
David G Decock, MD
- Surgery Physician
- Madison, WI
National Provider Identifier
1417990813
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- 17943-020
- Practice address
- 700 S Park St
Dean & St. Mary'S Outpatient Center
Madison, WI 53715-1830 - Phone
- (608) 260-2900
- NPI assigned
- Jun 14, 2006
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Surgery Physician | 208600000X | 17943-020 | WI | Primary |
Addresses
Primary practice location
700 S Park St
Dean & St. Mary'S Outpatient Center
Madison, WI 53715-1830
Mailing address
700 S Park St
Dean & St. Mary'S Outpatient Center
Madison, WI 53715-1830
Phone (608) 260-2900
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 30307000 | Medicaid | WI | |
| 177 | Other | WI | DEAN HEALTH INSURANCE |
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 |
|---|---|---|---|
| 17943-020 | WI | MD | Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150243200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1263945600000",
"number": "1417990813",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "700 S PARK ST",
"address_2": "DEAN & ST. MARY'S OUTPATIENT CENTER",
"city": "MADISON",
"state": "WI",
"postal_code": "537151830",
"telephone_number": "608-260-2900"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "700 S PARK ST",
"address_2": "DEAN & ST. MARY'S OUTPATIENT CENTER",
"city": "MADISON",
"state": "WI",
"postal_code": "537151830",
"telephone_number": "608-260-2900"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DECOCK",
"first_name": "DAVID",
"middle_name": "G",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-14",
"last_updated": "2010-01-20",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "WI",
"license": "17943-020",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "30307000",
"state": "WI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DEAN HEALTH INSURANCE",
"identifier": "177",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Madison, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.