Individual provider Active NPI

Susan O Messerly, DO

  • Pediatrics Physician
  • Medford, WI
National Provider Identifier
1447261706
Registry record updated May 16, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
33749 Issued in WI
Practice address
143 S Gibson St
Medford, WI 54451-1622
Phone
(715) 748-2121
NPI assigned
Aug 11, 2006
Last updated
May 16, 2012By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 16, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 33749 WI Primary

Addresses

Primary practice location

143 S Gibson St
Medford, WI 54451-1622

Mailing address

143 South Gibson Street
Medford, WI 54451-1622
Phone (715) 748-2121

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
I20050822000214 WI Practitioner - Pediatric MedicinePractitioner - Other (Physician) 9931139771 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
33749WIMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Aspirus Medford Hospital & Clinics, Inc. Current Accepting new patients
Aspirus Medford Hospital & Clinics, Inc. CurrentSince Jan 10, 2016 Accepting new patients
Aspirus Medford Hospital & Clinics, Inc. CurrentSince Jan 10, 2016 Accepting new patients

Locations

29980 Network Pl
Chicago, IL 60673

135 S Gibson St
Medford, WI 54451
Phone (715) 748-8100

143 S Gibson St
Medford, WI 54451
Phone (715) 748-2121

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1155254400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1337126400000",
    "number": "1447261706",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "143 SOUTH GIBSON STREET",
            "city": "MEDFORD",
            "state": "WI",
            "postal_code": "544511622",
            "telephone_number": "715-748-2121"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "143 S GIBSON ST",
            "city": "MEDFORD",
            "state": "WI",
            "postal_code": "544511622",
            "telephone_number": "715-748-2121"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MESSERLY",
        "first_name": "SUSAN",
        "middle_name": "O",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-11",
        "last_updated": "2012-05-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "WI",
            "license": "33749",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Medford, WI

Sources for this page

Verify at the official NPI Registry.