NPIMap

Organization Active NPI

Hometown Physician Services MD, S.C.

  • Family Medicine Physician
  • Woodville, WI
National Provider Identifier
1558832055
Registry record updated Dec 16, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
HOMETOWN PHYSICIAN SERVICES MD, S.C.
Practice address
401 Finvold St
Woodville, WI 54028
Phone
(617) 304-2262
NPI assigned
Dec 9, 2018
Last updated
Dec 16, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 16, 2019

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

Authorized official

Name
Jeffrey Hendricks
Title
Mso Administrator
Phone
(617) 304-2262

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X Primary

Addresses

Primary practice location

401 Finvold St
Woodville, WI 54028

Mailing address

401 Finvold St
Woodville, WI 54028-9719

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI, MN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20190304002167 WI Part B Supplier - Clinic/Group Practice 3577802859 Receives reassigned benefits from 6 practitioners
Practice locations: Woodville, WI
O20190715000330 MN Part B Supplier - Clinic/Group Practice 3577802859 Receives reassigned benefits from 6 practitioners
Practice locations: Woodbury, MN

National Provider Directory

National Provider Directory

Locations

8687 Eagle Point Blvd
Lake Elmo, MN 55042
Phone (715) 600-0549

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1544313600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1576454400000",
    "number": "1558832055",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 FINVOLD ST",
            "city": "WOODVILLE",
            "state": "WI",
            "postal_code": "540289719"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 FINVOLD ST",
            "city": "WOODVILLE",
            "state": "WI",
            "postal_code": "54028",
            "telephone_number": "617-304-2262"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HOMETOWN PHYSICIAN SERVICES MD, S.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-12-09",
        "last_updated": "2019-12-16",
        "certification_date": "2019-12-16",
        "status": "A",
        "authorized_official_last_name": "HENDRICKS",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_title_or_position": "MSO ADMINISTRATOR",
        "authorized_official_telephone_number": "617-304-2262"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Woodville, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 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.