Active NPI
Neelakantan Namboodiri, MD
- Nephrology Physician
- Rice Lake, WI
National Provider Identifier
1437259173
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nephrology Physician
- License
- 39709
- Practice address
- 1700 W Stout St
Rice Lake, WI 54868-5000 - Phone
- (715) 236-8100
- NPI assigned
- Sep 23, 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 |
|---|---|---|---|---|
| Nephrology Physician | 207RN0300X | 39709 | WI | Primary |
Addresses
Primary practice location
1700 W Stout St
Rice Lake, WI 54868-5000
Mailing address
1000 N Oak Avenue
Marshfield, WI 54449-5703
Phone (715) 387-5511
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 32459200 | 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 |
|---|---|---|---|
| 39709 | WI | MD | Nephrology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158969600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1255046400000",
"number": "1437259173",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1000 N OAK AVENUE",
"city": "MARSHFIELD",
"state": "WI",
"postal_code": "544495703",
"telephone_number": "715-387-5511"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1700 W STOUT ST",
"city": "RICE LAKE",
"state": "WI",
"postal_code": "548685000",
"telephone_number": "715-236-8100"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NAMBOODIRI",
"first_name": "NEELAKANTAN",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-23",
"last_updated": "2009-10-09",
"status": "A"
},
"taxonomies": [
{
"code": "207RN0300X",
"taxonomy_group": "",
"desc": "Internal Medicine, Nephrology",
"state": "WI",
"license": "39709",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "32459200",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Rice Lake, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 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.