Active NPI
Jeannie M Waschow, DPM
- Podiatrist
- Iron Mountain, MI
National Provider Identifier
1497739700
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Podiatrist
- License
- 016004344
- Practice address
- 325 E H St
Iron Mountain, MI 49801-4792 - Phone
- (906) 774-3300
- Fax
- (906) 779-3144
- NPI assigned
- Nov 30, 2005
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Podiatrist | 213E00000X | 016004344 | IL | Primary |
Addresses
Primary practice location
325 E H St
Iron Mountain, MI 49801-4792
Mailing address
325 E H St
Iron Mountain, MI 49801-4792
Phone (906) 774-3300
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| P00384162 | Other | IL | MEDICARE RAILROAD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 016004344 | IL | MD | Podiatrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1133308800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1545350400000",
"number": "1497739700",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "325 E H ST",
"city": "IRON MOUNTAIN",
"state": "MI",
"postal_code": "498014792",
"telephone_number": "906-774-3300",
"fax_number": "906-779-3144"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "325 E H ST",
"city": "IRON MOUNTAIN",
"state": "MI",
"postal_code": "498014792",
"telephone_number": "906-774-3300",
"fax_number": "906-779-3144"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WASCHOW",
"first_name": "JEANNIE",
"middle_name": "M",
"name_prefix": "Mrs.",
"credential": "DPM",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2005-11-30",
"last_updated": "2018-12-21",
"status": "A"
},
"taxonomies": [
{
"code": "213E00000X",
"taxonomy_group": "",
"desc": "Podiatrist",
"state": "IL",
"license": "016004344",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE RAILROAD",
"identifier": "P00384162",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Iron Mountain, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.