Active NPI
Jack R Behm, C.R.N.A.
- Anesthesiology Physician
- New London, WI
National Provider Identifier
1578769717
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anesthesiology Physician
- License
- 56169-30
- Practice address
- 1405 Mill St
New London, WI 54961-2155 - Phone
- (920) 531-2037
- Fax
- (920) 531-2015
- NPI assigned
- Jun 25, 2007
- 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 |
|---|---|---|---|---|
| Anesthesiology Physician | 207L00000X | 56169-30 | WI | Primary |
Addresses
Primary practice location
1405 Mill St
New London, WI 54961-2155
Mailing address
N7147 Highway 49
Weyauwega, WI 54983
Phone (920) 867-3444
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 56169-30 | WI | MD | Anesthesiology Physician |
| 56169 | WI | MD | Pediatric Anesthesiology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1182729600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1578769717",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "N7147 HIGHWAY 49",
"city": "WEYAUWEGA",
"state": "WI",
"postal_code": "54983",
"telephone_number": "920-867-3444"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1405 MILL ST",
"city": "NEW LONDON",
"state": "WI",
"postal_code": "549612155",
"telephone_number": "920-531-2037",
"fax_number": "920-531-2015"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BEHM",
"first_name": "JACK",
"middle_name": "R",
"credential": "C.R.N.A.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-06-25",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207L00000X",
"taxonomy_group": "",
"desc": "Anesthesiology",
"state": "WI",
"license": "56169-30",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in New London, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.