NPIMap

Organization Active NPI

Provisions Health

  • Family Medicine Physician
  • Eau Claire, WI
National Provider Identifier
1508875840
Registry record updated Dec 11, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
PROVISIONS HEALTH
Practice address
2522 Golf Rd Ste 2
Eau Claire, WI 54701-6033
Phone
(715) 833-0660
NPI assigned
Aug 5, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 11, 2022

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

Authorized official

Name
Shannon Wiggins, D.O.NPI 1295744530
Title
Physician
Phone
(517) 346-7628

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X 5101013727 MI
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

2522 Golf Rd Ste 2
Eau Claire, WI 54701-6033

Mailing address

9557 S Airport Rd
Dewitt, MI 48820-9104

Other identifiers 1

IdentifierTypeStateIssuer
22-76363OtherWIMEDICAL LICENSE

National Provider Directory

National Provider Directory

Locations

2522 Golf Rd
Ste 2
Eau Claire, WI 54701
Phone (715) 563-8393

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1154736000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1670716800000",
    "number": "1508875840",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9557 S AIRPORT RD",
            "city": "DEWITT",
            "state": "MI",
            "postal_code": "488209104"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2522 GOLF RD STE 2",
            "city": "EAU CLAIRE",
            "state": "WI",
            "postal_code": "547016033",
            "telephone_number": "715-833-0660"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVISIONS HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-05",
        "last_updated": "2022-12-11",
        "certification_date": "2022-12-11",
        "status": "A",
        "authorized_official_last_name": "WIGGINS",
        "authorized_official_first_name": "SHANNON",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "517-346-7628",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "5101013727",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE",
            "identifier": "22-76363",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Eau Claire, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.