Individual provider Active NPI

Peter David Holzwarth, MD

  • Pediatrics Physician
  • Neenah, WI
National Provider Identifier
1629001912
Registry record updated Jan 14, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
35954 Issued in WI
Practice address
120 Second Street
Neenah, WI 54956-2883
Phone
(920) 969-7900
Fax
(920) 969-7979
NPI assigned
Jul 9, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 14, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 35954 WI Primary

Addresses

Primary practice location

120 Second Street
Neenah, WI 54956-2883

Mailing address

9000 W Wisconsin Ave # Ms 958
Milwaukee, WI 53226-4874
Phone (414) 266-7615

Other identifiers 1

IdentifierTypeStateIssuer
1629001912MedicaidWI

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
I20090918000485 WI Practitioner - Pediatric Medicine 7012063878 Reassigns benefits to 3 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
35954WIMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Ascension NE Wisconsin, Inc CurrentSince Mar 10, 2022 Accepting new patients
Butte Des Morts Pathology, S.C. Current Accepting new patients
Ascension Medical Group-Fox Valley Wisconsin, Inc CurrentSince Mar 10, 2022 Accepting new patients
Thedacare, Incorporated CurrentSince Mar 23, 2019 Accepting new patients
Ascension NE Wisconsin, Inc CurrentSince Mar 10, 2022 Accepting new patients
Ascension Medical Group-Fox Valley Wisconsin, Inc CurrentSince Mar 10, 2022 Accepting new patients

Locations

1506 S Oneida St
Appleton, WI 54915
Phone (920) 730-4950

4480 W Spencer St
Appleton, WI 54914
Phone (920) 738-4800

1818 N Meade St
Appleton, WI 54911
Phone (920) 731-4101

1501 S Madison St
Appleton, WI 54915
Phone (920) 730-4435

614 Memorial Dr
Chilton, WI 53014
Phone (800) 458-4042

835 S Van Buren St
Green Bay, WI 54301
Phone (888) 901-7246

2700 W 9th Ave
Oshkosh, WI 54904
Phone (920) 223-0220

500 S Oakwood Rd
Oshkosh, WI 54904
Phone (920) 223-0501

Interoperability endpoints

  • Direct secure messaging: pholzwarth206198@direct.thedacare.org

Organizations & group practices 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1152403200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1547424000000",
    "number": "1629001912",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9000 W WISCONSIN AVE # MS 958",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532264874",
            "telephone_number": "414-266-7615",
            "fax_number": "414-266-6238"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 SECOND STREET",
            "city": "NEENAH",
            "state": "WI",
            "postal_code": "549562883",
            "telephone_number": "920-969-7900",
            "fax_number": "920-969-7979"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOLZWARTH",
        "first_name": "PETER",
        "middle_name": "DAVID",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-09",
        "last_updated": "2019-01-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "WI",
            "license": "35954",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1629001912",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Neenah, WI

Sources for this page

Verify at the official NPI Registry.