NPIMap

Individual provider Active NPI

Jerome E Bormes, MD

  • Anesthesiology Physician
  • Neenah, WI
National Provider Identifier
1477540631
Registry record updated Oct 31, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
34035-020 Issued in WI
Practice address
130 2ND St
Ste. A107
Neenah, WI 54956-2883
Phone
(920) 729-3332
NPI assigned
Oct 4, 2005
Sex
Male
Sole proprietor
No

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 12

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
Sanford School of Medicine of University of South Dakota, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Association of Hospital Anesthesiologists SC 84 clinicians

Practice addresses (Care Compare)

130 2ND St
Neenah, WI 54956-2883
Phone (920) 729-3100

1818 N Meade St
Appleton, WI 54911-3454
Phone (920) 731-4101

225 Memorial Dr
Berlin, WI 54923-1243
Phone (920) 361-1313

2400 Witzel Ave C
Oshkosh, WI 54904-8375
Phone (920) 651-6900

Hospital & facility affiliations

  • Thedacare Regional Med Ctr - Neenah Hospital, Neenah, WI, CCN 520045
  • Thedacare Regional Medical Center - Appleton Inc Hospital, Appleton, WI, CCN 520160

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Medicare enrollment records 1

Medicare enrollment files
Enrollment IDStateProvider typePAC IDDetails
I20100527000308 WI Practitioner - Anesthesiology 6507842903 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
34035-020WIMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Association of Hospital Anesthesiologists SC Anesthesiology CurrentSince Feb 1, 2003 Accepting new patients
Mid-America Retina Consultants PA PastSince Feb 1, 1995 Accepting new patients

Locations

804 Scott Nixon Memorial Dr
Martinez, GA 30907

1818 N Meade St
Appleton, WI 54911
Phone (920) 731-4101

736 Ford St
Kimberly, WI 54136

130 2nd St
Ste A107
Neenah, WI 54956
Phone (920) 725-5181

130 2nd St
#A107
Neenah, WI 54956

130 2nd St
Neenah, WI 54956
Phone (920) 729-2063

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X 34035-020 WI Primary

Addresses

NPPES NPI Registry

Primary practice location

130 2ND St
Ste. A107
Neenah, WI 54956-2883

Mailing address

804 Scott Nixon Memorial Dr
Augusta, GA 30907-2464
Phone (920) 729-3332

Other identifiers 1

NPPES NPI Registry
IdentifierTypeStateIssuer
31915300MedicaidWI

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Oct 31, 2007.

{
    "created_epoch": "1128384000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1193788800000",
    "number": "1477540631",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "804 SCOTT NIXON MEMORIAL DR",
            "city": "AUGUSTA",
            "state": "GA",
            "postal_code": "309072464",
            "telephone_number": "920-729-3332"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 2ND ST",
            "address_2": "STE. A107",
            "city": "NEENAH",
            "state": "WI",
            "postal_code": "549562883",
            "telephone_number": "920-729-3332"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BORMES",
        "first_name": "JEROME",
        "middle_name": "E",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-04",
        "last_updated": "2007-10-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "WI",
            "license": "34035-020",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "31915300",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Neenah, WI

Sources for this page

Verify at the official NPI Registry.