NPIMap

Organization Active NPI

Shawano Clinic, Inc

Doing business as ThedaCare Physicians Shawano

  • Family Medicine Physician
  • Shawano, WI
National Provider Identifier
1437272135
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
SHAWANO CLINIC, INC
Doing business as
ThedaCare Physicians Shawano
Practice address
117 E Green Bay St
Shawano, WI 54166-2443
Phone
(920) 996-3298
NPI assigned
Apr 9, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Jennifer L Thern
Title
Reimbursment Specialist
Phone
(920) 996-3298

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

117 E Green Bay St
Shawano, WI 54166-2443

Mailing address

PO Box 8003
Appleton, WI 54912-8003

Other names 1

  • ThedaCare Physicians Shawano Doing business as

National Provider Directory

National Provider Directory

Locations

32 Hughes St
Clintonville, WI 54929
Phone (715) 823-5161

149 N McKenzie Ave
Gillett, WI 54124
Phone (920) 855-2126

117 E Green Bay St
Shawano, WI 54166
Phone (715) 256-3000

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1176076800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1437272135",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 8003",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549128003"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "117 E GREEN BAY ST",
            "city": "SHAWANO",
            "state": "WI",
            "postal_code": "541662443",
            "telephone_number": "920-996-3298"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHAWANO CLINIC, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-09",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "THERN",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "REIMBURSMENT SPECIALIST",
        "authorized_official_telephone_number": "920-996-3298"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ThedaCare Physicians Shawano",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Shawano, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.