Individual provider Active NPI

John Snellgrove, MD

  • Emergency Medicine Physician
  • Fond Du Lac, WI
National Provider Identifier
1609337427
Registry record updated Jul 19, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
7463420 Issued in WI
Practice address
430 E Division St
Fond Du Lac, WI 54935-4597
Phone
(920) 929-2300
NPI assigned
Mar 26, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 19, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Emergency Medicine Physician 207P00000X 7463420 WI Primary

Addresses

Primary practice location

430 E Division St
Fond Du Lac, WI 54935-4597

Mailing address

700 S Park St
Madison, WI 53715-1830

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI, AL2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20220719001905 WI Practitioner - Emergency Medicine 3870923758 Reassigns benefits to 2 organizations
I20230321000109 AL Practitioner - Emergency Medicine 3870923758 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

3690 Grandview Pkwy
Birmingham, AL 35243-3326
Phone (205) 971-1000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
79.19 of 100Reported as group
Quality
74.01
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
7463420WIMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Trinity Emergency Physicians LLC Emergency Medicine CurrentSince Feb 22, 2023 Accepting new patients
Reedsburg Area Medical Center Inc CurrentSince Jun 1, 2022 Accepting new patients
Reedsburg Area Medical Center, Inc. CurrentSince Jun 1, 2022 Accepting new patients
Trinity Emergency Physicians, LLC Emergency Medicine CurrentSince Feb 22, 2023 Accepting new patients

Locations

3690 Grandview Pkwy
Vestavia, AL 35243
Phone (205) 592-1000

2000 N Dewey Ave
Reedsburg, WI 53959
Phone (608) 524-6487

Organizations & group practices 5

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.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1553558400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658188800000",
    "number": "1609337427",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 S PARK ST",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537151830"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "430 E DIVISION ST",
            "city": "FOND DU LAC",
            "state": "WI",
            "postal_code": "549354597",
            "telephone_number": "920-929-2300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SNELLGROVE",
        "first_name": "JOHN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-03-26",
        "last_updated": "2022-07-19",
        "certification_date": "2022-07-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "WI",
            "license": "7463420",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fond Du Lac, WI

Sources for this page

Verify at the official NPI Registry.