Individual provider Active NPI

Timothy A Lippold, AU.D.

  • Audiologist
  • Wisconsin Rapids, WI
National Provider Identifier
1538370440
Registry record updated May 8, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
AudiologistTaxonomy code 231H00000X
License
296-156 Issued in WI
Practice address
2821 8TH St S
Wisconsin Rapids, WI 54494-6294
Phone
(715) 423-4327
Fax
(715) 421-3300
NPI assigned
May 24, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 8, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Audiologist-Hearing Aid Fitter 237600000X 296-156 WI
Audiologist 231H00000X 296-156 WI Primary

Addresses

Primary practice location

2821 8TH St S
Wisconsin Rapids, WI 54494-6294

Mailing address

2821 8TH St S
Wisconsin Rapids, WI 54494-6294
Phone (715) 423-4327

Other practice location 1

1490 Rivers Edge Trl
Altoona, WI 54720-2755
Phone (715) 828-2368

Other identifiers 1

IdentifierTypeStateIssuer
41101700MedicaidWI

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140424000261 WI Practitioner - Qualified Audiologist 1557593043 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
296-156WIMDAudiologist-Hearing Aid Fitter

Practice roles

OrganizationSpecialtyStatusNew patients
Defatta ENT & Facial Plastic Surgery SC CurrentSince Nov 8, 2018 Accepting new patients

Locations

1490 Rivers Edge Trl
Altoona, WI 54720
Phone (715) 828-2368

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1179964800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1557273600000",
    "number": "1538370440",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2821 8TH ST S",
            "city": "WISCONSIN RAPIDS",
            "state": "WI",
            "postal_code": "544946294",
            "telephone_number": "715-423-4327",
            "fax_number": "715-421-3300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2821 8TH ST S",
            "city": "WISCONSIN RAPIDS",
            "state": "WI",
            "postal_code": "544946294",
            "telephone_number": "715-423-4327",
            "fax_number": "715-421-3300"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1490 Rivers Edge Trl",
            "address_purpose": "LOCATION",
            "city": "Altoona",
            "state": "WI",
            "postal_code": "547202755",
            "country_code": "US",
            "telephone_number": "715-828-2368",
            "fax_number": "715-839-7796",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LIPPOLD",
        "first_name": "TIMOTHY",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "AU.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-24",
        "last_updated": "2019-05-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "237600000X",
            "taxonomy_group": "",
            "desc": "Audiologist-Hearing Aid Fitter",
            "state": "WI",
            "license": "296-156",
            "primary": false
        },
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": "WI",
            "license": "296-156",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "41101700",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wisconsin Rapids, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2019; 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.