Active NPI
Douglas J Cronin, PA-C
- Physician Assistant
- Beaver Dam, WI
National Provider Identifier
1487605937
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 81-023
- Practice address
- 705 S University Ave
Ste 510
Beaver Dam, WI 53916-3081 - Phone
- (920) 887-3102
- Fax
- (920) 885-8788
- NPI assigned
- May 12, 2006
- Last updated
- Jul 7, 2009
- 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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 81-023 | WI | Primary |
Addresses
Primary practice location
705 S University Ave
Ste 510
Beaver Dam, WI 53916-3081
Mailing address
705 S University Ave
Ste 510
Beaver Dam, WI 53916-3081
Phone (920) 887-3102
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2055 | Other | WI | DEAN HEALTH INSURANCE |
| 1001738 | Other | WI | PHYSICIANS PLUS |
| 42905400 | 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
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 81-023 | WI | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dean Health Systems, Inc, | Past | Accepting new patients |
Organizations & group practices 1
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.
-
dba Dean Clinic-Beaver Dam Family & Sports Orthopedic Center
- Durable Medical Equipment & Medical Supplies
- Beaver Dam, WI
- NPI 1336425016
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147392000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1246924800000",
"number": "1487605937",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "705 S UNIVERSITY AVE",
"address_2": "STE 510",
"city": "BEAVER DAM",
"state": "WI",
"postal_code": "539163081",
"telephone_number": "920-887-3102",
"fax_number": "920-885-8788"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "705 S UNIVERSITY AVE",
"address_2": "STE 510",
"city": "BEAVER DAM",
"state": "WI",
"postal_code": "539163081",
"telephone_number": "920-887-3102",
"fax_number": "920-885-8788"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CRONIN",
"first_name": "DOUGLAS",
"middle_name": "J",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-12",
"last_updated": "2009-07-07",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "WI",
"license": "81-023",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DEAN HEALTH INSURANCE",
"identifier": "2055",
"state": "WI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PHYSICIANS PLUS",
"identifier": "1001738",
"state": "WI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "42905400",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Beaver Dam, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 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.