Active NPI
Thomas W Grossman Jr., M.D.
- Orthopaedic Surgery Physician
- Waupun, WI
National Provider Identifier
1699749689
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthopaedic Surgery Physician
- License
- 36420
- Practice address
- 608 W Brown St
Waupun, WI 53963-1702 - Phone
- (920) 324-6802
- NPI assigned
- Feb 15, 2006
- 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 |
|---|---|---|---|---|
| Orthopaedic Surgery Physician | 207X00000X | 36420 | WI | Primary |
Addresses
Primary practice location
608 W Brown St
Waupun, WI 53963-1702
Mailing address
420 E Division St
Fond Du Lac, WI 54935-4560
Phone (920) 926-8340
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 32523000 | 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
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Watertown Orthopedics LTD | Orthopaedic Surgery | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Orthopaedic Surgery Physician
- Watertown, WI
- NPI 1366414807
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1139961600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1455667200000",
"number": "1699749689",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "420 E DIVISION ST",
"city": "FOND DU LAC",
"state": "WI",
"postal_code": "549354560",
"telephone_number": "920-926-8340"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "608 W BROWN ST",
"city": "WAUPUN",
"state": "WI",
"postal_code": "539631702",
"telephone_number": "920-324-6802"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GROSSMAN",
"first_name": "THOMAS",
"middle_name": "W",
"name_suffix": "Jr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-02-15",
"last_updated": "2016-02-17",
"status": "A"
},
"taxonomies": [
{
"code": "207X00000X",
"taxonomy_group": "",
"desc": "Orthopaedic Surgery",
"state": "WI",
"license": "36420",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "32523000",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Waupun, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.