Active NPI
Mark W Kehrberg, MD
- Pediatrics Physician
- Oshkosh, WI
National Provider Identifier
1679567473
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 34342
- Practice address
- 1855 S Koeller St
Oshkosh, WI 54902-6186 - Phone
- (920) 223-7200
- NPI assigned
- Sep 7, 2005
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 34342 | WI | Primary |
Addresses
Primary practice location
1855 S Koeller St
Oshkosh, WI 54902-6186
Mailing address
500 S Oakwood Rd
Oshkosh, WI 54904-7944
Phone (920) 223-0501
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 31916300 | 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
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 34342 | WI | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ascension Medical Group-Fox Valley Wisconsin, Inc | Past | Accepting new patients | |
| Mercy Medical Center of Oshkosh, Inc. | Past | Accepting new patients |
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.
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NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1126051200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1220313600000",
"number": "1679567473",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "500 S OAKWOOD RD",
"city": "OSHKOSH",
"state": "WI",
"postal_code": "549047944",
"telephone_number": "920-223-0501"
},
{
"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": "920-223-7200"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KEHRBERG",
"first_name": "MARK",
"middle_name": "W",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-09-07",
"last_updated": "2008-09-02",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "WI",
"license": "34342",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "31916300",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Oshkosh, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.