Individual provider Active NPI

Junith M Thompson, MD

  • Obstetrics & Gynecology Physician
  • Kenosha, WI
National Provider Identifier
1558413161
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
29980020 Issued in WI
Practice address
6530 Sheridan Road
Kenosha, WI 53143
Phone
(262) 657-8360
Fax
(262) 657-8389
NPI assigned
Jan 17, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X 29980020 WI Primary

Addresses

Primary practice location

6530 Sheridan Road
Kenosha, WI 53143

Mailing address

6530 Sheridan Road
Kenosha, WI 53143
Phone (262) 657-8360

Other identifiers 2

IdentifierTypeStateIssuer
31520900MedicaidWI
29980020OtherWISTATE LICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110503000711 WI Practitioner - Obstetrics/Gynecology 0547444903

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
29980020WIMDObstetrics & Gynecology Physician

NPI Registry JSON

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

{
    "created_epoch": "1168992000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1558413161",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6530 SHERIDAN ROAD",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "53143",
            "telephone_number": "262-657-8360",
            "fax_number": "262-657-8389"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6530 SHERIDAN ROAD",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "53143",
            "telephone_number": "262-657-8360",
            "fax_number": "262-657-8389"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THOMPSON",
        "first_name": "JUNITH",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-17",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "WI",
            "license": "29980020",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "31520900",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "29980020",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kenosha, WI

Sources for this page

Verify at the official NPI Registry.