Simon Edwin Roselaar, MD
Individual provider Active NPI Cardiovascular Disease Physician · Appleton, WI
NPI 1689626632 · NPPES record last updated Mar 26, 2020
Key facts
- NPI
- 1689626632
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Cardiovascular Disease Physician 207RC0000X
- License
- 40974-020 (WI)
- Practice address
- 5045 W Grande Market Dr
Appleton, WI 54913-8517 - Phone
- (920) 886-9380
- Fax
- (920) 886-9381
- NPI assigned
- May 17, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 4
Hospital & facility affiliations 17
Medicare Care Compare profile
- Specialty
- Cardiovascular Disease (Cardiology)
- Education
- Other, 1994
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Ascension Medical Group-Fox Valley Wisconsin, Inc
Practice addresses (Care Compare)
1506 S Oneida St
Appleton, WI 54915-1305
Phone (920) 738-2000
Hospital & facility affiliations
- Ascension NE Wisconsin - St Elizabeth Campus
- Thedacare Regional Medical Center - Appleton Inc
- Thedacare Medical Center - Berlin Inc
- Thedacare Regional Med Ctr - Neenah
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20050222000561 | WI | Practitioner - Cardiovascular Disease (Cardiology) | 8325951338 | Reassigns benefits to 5 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 40974-020 | WI | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Heart and Vascular of Wisconsin, SC | Cardiovascular Disease | Current |
Accepting new patients |
| Ascension Medical Group-Fox Valley Wisconsin, Inc | Current |
Accepting new patients | |
| Ascension Medical Group-Fox Valley Wisconsin, Inc | Cardiovascular Disease | Current |
Accepting new patients |
| Ascension Calumet Hospital, Inc | Current |
Accepting new patients |
Locations
1501 S Madison St
Appleton, WI 54915
Phone (920) 730-4435
1818 N Meade St
Appleton, WI 54911
Phone (920) 731-4101
1506 S Oneida St
Appleton, WI 54915
Phone (920) 730-4950
5045 W Grande Market Dr
Appleton, WI 54913
Phone (920) 747-0505
225 Memorial Dr
Berlin, WI 54923
Phone (920) 361-1313
614 Memorial Dr
Chilton, WI 53014
Phone (800) 458-4042
200 Theda Clark Medical Plz
Ste 320
Neenah, WI 54956
Phone (920) 722-3341
1405 Mill St
New London, WI 54961
Phone (920) 531-2000
1420 Algoma St
New London, WI 54961
Phone (920) 828-8300
2700 W 9th Ave
Oshkosh, WI 54904
Phone (920) 223-0220
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 40974-020 | WI | |
| Nuclear Cardiology Physician | 207UN0901X | 40974-020 | WI | |
| Cardiovascular Disease Physician | 207RC0000X | 40974-020 | WI | Yes |
Addresses
Primary practice location
5045 W Grande Market Dr
Appleton, WI 54913-8517
Mailing address
Bin 88040
Milwaukee, WI 53288-0040
Phone (920) 886-9380
Other providers in Appleton, WI
- Michael Gavin Romenesko
- Richard Lee Romenesko Sr.
- Bethany Romesser
- Ronald W Schauland, Crna, LLC
- Kristen M Rose
- Casey Rosendahl
- Tanya Rosenthal
- Lori Jean Rosin
- Jennifer Ross
- Amanda Roth
All providers in Appleton, WI · Cardiovascular Disease Physician in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 26, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.