Individual provider Active NPI

David Eugene Coleman, MD

  • Family Medicine Physician
  • Oshkosh, WI
National Provider Identifier
1639170301
Registry record updated Jan 5, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
25223-020 Issued in WI
Practice address
1855 S Koeller St
Oshkosh, WI 54902-6186
Phone
(920) 223-4410
NPI assigned
Aug 3, 2005
Last updated
Jan 5, 2017By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 5, 2017

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Personal Emergency Response Attendant 146D00000X WI
Emergency Medicine Physician 207P00000X 25223 WI
Family Medicine Physician 207Q00000X 25223-020 WI Primary
Surgery Physician 208600000X 25223-020 WI

Addresses

Primary practice location

1855 S Koeller St
Oshkosh, WI 54902-6186

Mailing address

4425 N Port Washington Rd
Ascension Corp
Glendale, WI 53212-1082
Phone (414) 326-2218

Other identifiers 1

IdentifierTypeStateIssuer
30527900MedicaidWI

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
I20040129000747 WI Practitioner - Emergency MedicinePractitioner - Family Practice 1759284599

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
25223WIMDEmergency Medicine Physician
25223-020WIMDSurgery Physician

NPI Registry JSON

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

{
    "created_epoch": "1123027200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1483574400000",
    "number": "1639170301",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4425 N PORT WASHINGTON RD",
            "address_2": "ASCENSION CORP",
            "city": "GLENDALE",
            "state": "WI",
            "postal_code": "532121082",
            "telephone_number": "414-326-2218"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1855 S KOELLER ST",
            "city": "OSHKOSH",
            "state": "WI",
            "postal_code": "549026186",
            "telephone_number": "920-223-4410"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COLEMAN",
        "first_name": "DAVID",
        "middle_name": "EUGENE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-03",
        "last_updated": "2017-01-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "146D00000X",
            "taxonomy_group": "",
            "desc": "Personal Emergency Response Attendant",
            "state": "WI",
            "license": null,
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "WI",
            "license": "25223",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "25223-020",
            "primary": true
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "WI",
            "license": "25223-020",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30527900",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Oshkosh, WI

Sources for this page

Verify at the official NPI Registry.