Active NPI
David Inserra
- Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
- Eagle River, WI
National Provider Identifier
1558082651
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
- License
- 051297939
- Practice address
- 108 W Wall St
Eagle River, WI 54521-9811 - Phone
- (715) 479-1069
- NPI assigned
- Sep 7, 2022
- Last updated
- Sep 7, 2022
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist | 1835P0018X | 051297939 | IL | Primary |
Addresses
Primary practice location
108 W Wall St
Eagle River, WI 54521-9811
Mailing address
108 W Wall St
Eagle River, WI 54521-9811
Phone (715) 479-1069
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 361924025 | Medicaid | WI |
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 051297939 | IL | MD | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Current | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients |
Locations
108 W Wall St
Eagle River, WI 54521
Phone (715) 479-1069
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": "1662508800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1662508800000",
"number": "1558082651",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "108 W WALL ST",
"city": "EAGLE RIVER",
"state": "WI",
"postal_code": "545219811",
"telephone_number": "715-479-1069",
"fax_number": "715-479-1370"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "108 W WALL ST",
"city": "EAGLE RIVER",
"state": "WI",
"postal_code": "545219811",
"telephone_number": "715-479-1069"
}
],
"practiceLocations": [],
"basic": {
"last_name": "INSERRA",
"first_name": "DAVID",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2022-09-07",
"last_updated": "2022-09-07",
"certification_date": "2022-09-07",
"status": "A"
},
"taxonomies": [
{
"code": "1835P0018X",
"taxonomy_group": "",
"desc": "Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist",
"state": "IL",
"license": "051297939",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "361924025",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Eagle River, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 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.