Active NPI
Jon T Tolliver, CSAC
- Counselor
- Hayward, WI
National Provider Identifier
1457572315
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- License
- 197
- Practice address
- 13380 W Trepania Rd
Hayward, WI 54843-2186 - Phone
- (715) 638-5107
- NPI assigned
- May 1, 2007
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Counselor | 101Y00000X | 197 | WI | Primary |
Addresses
Primary practice location
13380 W Trepania Rd
Hayward, WI 54843-2186
Mailing address
63285 Franciskovich Rd
Ashland, WI 54806-1084
Phone (715) 746-2664
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 39395500 | 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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 197 | WI | MD | Gastroenterology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1177977600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1457572315",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "63285 FRANCISKOVICH RD",
"city": "ASHLAND",
"state": "WI",
"postal_code": "548061084",
"telephone_number": "715-746-2664"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13380 W TREPANIA RD",
"city": "HAYWARD",
"state": "WI",
"postal_code": "548432186",
"telephone_number": "715-638-5107"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TOLLIVER",
"first_name": "JON",
"middle_name": "T",
"name_prefix": "Mr.",
"credential": "CSAC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-05-01",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "WI",
"license": "197",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "39395500",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Hayward, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.