Individual provider Active NPI

Julie Ann Gobler, AUD, CCC-A

  • Audiologist
  • West Bend, WI
National Provider Identifier
1518111491
Registry record updated Sep 30, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
AudiologistTaxonomy code 231H00000X
License
242-156 Issued in WI
Practice address
1305 Chestnut St
West Bend, WI 53095-3060
Phone
(262) 338-3553
NPI assigned
Nov 5, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 30, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Audiologist 231H00000X 242-156 WI Primary

Addresses

Primary practice location

1305 Chestnut St
West Bend, WI 53095-3060

Mailing address

1305 Chestnut St
West Bend, WI 53095-3060
Phone (262) 338-3553

Other identifiers 1

IdentifierTypeStateIssuer
41131100MedicaidWI

Other names 1

  • Julie Ann Larson Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110218000318 WI Practitioner - Qualified Audiologist 6002097458 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
242WIMDPsychologist
242-156WIMDAudiologist

Practice roles

OrganizationSpecialtyStatusNew patients
Family Hearing Care, LLC Audiologist CurrentSince Oct 15, 2014 Accepting new patients
Milwaukee Ear Nose Throat Clinic Limited Audiologist Past Accepting new patients
Milwaukee ENT Speech & Hearing Aid Service Past Accepting new patients

Locations

1305 Chestnut St
West Bend, WI 53095
Phone (262) 335-4202

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1225843200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1412035200000",
    "number": "1518111491",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1305 CHESTNUT ST",
            "city": "WEST BEND",
            "state": "WI",
            "postal_code": "530953060",
            "telephone_number": "262-338-3553"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1305 CHESTNUT ST",
            "city": "WEST BEND",
            "state": "WI",
            "postal_code": "530953060",
            "telephone_number": "262-338-3553"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOBLER",
        "first_name": "JULIE",
        "middle_name": "ANN",
        "name_prefix": "Dr.",
        "credential": "AUD, CCC-A",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-11-05",
        "last_updated": "2014-09-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": "WI",
            "license": "242-156",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "41131100",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JULIE",
            "last_name": "LARSON",
            "middle_name": "ANN",
            "credential": "MA, CCC-A",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in West Bend, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.