Individual provider Active NPI

Shayne D Fehr, M.D.

  • Sports Medicine (Orthopaedic Surgery) Physician
  • Milwaukee, WI
National Provider Identifier
1659587244
Registry record updated Jun 13, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Medicine (Orthopaedic Surgery) PhysicianTaxonomy code 207XX0005X
License
55847 Issued in WI
Practice address
3365 S 103Rd St
Pediatric Sports Medicine
Milwaukee, WI 53227-4161
Phone
(414) 955-2600
Fax
(414) 955-6440
NPI assigned
May 14, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 13, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Medicine (Orthopaedic Surgery) Physician 207XX0005X 55847 WI Primary

Addresses

Primary practice location

3365 S 103Rd St
Pediatric Sports Medicine
Milwaukee, WI 53227-4161

Mailing address

3365 S 103Rd St
Pediatric Sports Medicine
Milwaukee, WI 53227-4161
Phone (414) 955-2600

Other identifiers 1

IdentifierTypeStateIssuer
1659587244MedicaidWI

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
I20110719000622 WI Practitioner - Orthopedic Surgery 9830367887 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
55847WIMDSports Medicine (Orthopaedic Surgery) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
The Medical College of Wisconsin, Inc. CurrentSince Aug 1, 2011 Accepting new patients
Children'S Specialty Group, Inc. Past Accepting new patients

Locations

3195 Hillside Dr
Delafield, WI 53018
Phone (262) 646-9950

10911 N Port Washington Rd
Mequon, WI 53092
Phone (262) 241-2080

3365 S 103rd St
Milwaukee, WI 53227
Phone (414) 321-3951

Bin 88350
Milwaukee, WI 53288
Phone (414) 805-3122

8701 Watertown Plank Rd
Wauwatosa, WI 53226
Phone (414) 456-4100

Interoperability endpoints

  • Direct secure messaging: sfehr5947@direct.chw.org

Organizations & group practices 2

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": "1179100800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1339545600000",
    "number": "1659587244",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3365 S 103RD ST",
            "address_2": "PEDIATRIC SPORTS MEDICINE",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532274161",
            "telephone_number": "414-955-2600",
            "fax_number": "414-955-6440"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3365 S 103RD ST",
            "address_2": "PEDIATRIC SPORTS MEDICINE",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532274161",
            "telephone_number": "414-955-2600",
            "fax_number": "414-955-6440"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FEHR",
        "first_name": "SHAYNE",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-14",
        "last_updated": "2012-06-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207XX0005X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Sports Medicine",
            "state": "WI",
            "license": "55847",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1659587244",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Milwaukee, WI

Sources for this page

Verify at the official NPI Registry.