Active NPI
Victoria D Pahl, PA-C
- Physician Assistant
- Wisconsin Rapids, WI
National Provider Identifier
1619256401
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 2765
- Practice address
- 420 Dewey St
Wisconsin Rapids, WI 54494-4714 - Phone
- (715) 421-1001
- NPI assigned
- Aug 10, 2011
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 2765 | WI | Primary |
Addresses
Primary practice location
420 Dewey St
Wisconsin Rapids, WI 54494-4714
Mailing address
2417 Post Rd
Stevens Point, WI 54481-6124
Phone (715) 690-1272
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619256401 | 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)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2765 | WI | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1312934400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1613692800000",
"number": "1619256401",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2417 POST RD",
"city": "STEVENS POINT",
"state": "WI",
"postal_code": "544816124",
"telephone_number": "715-690-1272",
"fax_number": "715-544-1212"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "420 DEWEY ST",
"city": "WISCONSIN RAPIDS",
"state": "WI",
"postal_code": "544944714",
"telephone_number": "715-421-1001"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PAHL",
"first_name": "VICTORIA",
"middle_name": "D",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-08-10",
"last_updated": "2021-02-19",
"certification_date": "2021-02-19",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "WI",
"license": "2765",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1619256401",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Wisconsin Rapids, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.