Individual provider Active NPI

George R. Schneider, MD

  • Internal Medicine Physician
  • Beaver Dam, WI
National Provider Identifier
1538109772
Registry record updated Jan 14, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
18465 Issued in WI
Practice address
705 S University Ave Ste 510
Beaver Dam, WI 53916-3081
Phone
(920) 887-3102
Fax
(920) 885-8788
NPI assigned
Jun 7, 2006
Last updated
Jan 14, 2011By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 14, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 18465 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 2

IdentifierTypeStateIssuer
61114OtherWIDEAN HEALTH PLAN
31210900MedicaidWI

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
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
18465WIMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Wisconsin Health Fund Past Accepting new patients
The Medical College of Wisconsin, Inc. Internal Medicine Past Accepting new patients

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1149638400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1294963200000",
    "number": "1538109772",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "705 S UNIVERSITY AVE 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 STE 510",
            "city": "BEAVER DAM",
            "state": "WI",
            "postal_code": "539163081",
            "telephone_number": "920-887-3102",
            "fax_number": "920-885-8788"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SCHNEIDER",
        "first_name": "GEORGE",
        "middle_name": "R.",
        "name_prefix": "Mr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-07",
        "last_updated": "2011-01-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WI",
            "license": "18465",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEAN HEALTH PLAN",
            "identifier": "61114",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "31210900",
            "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 Jan 14, 2011; 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.