Jan Bublik, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

050499-1 Issued in NY

Practice address

210 Independence LN
Wausau, WI 54403-5197

Phone

(715) 203-1305

Fax

(866) 906-0578

NPI assigned

Sep 26, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Aug 15, 2013 through Aug 15, 2027

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1159228800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1301961600000",
    "number": "1700987302",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "210 INDEPENDENCE LN",
            "city": "WAUSAU",
            "state": "WI",
            "postal_code": "544035197",
            "telephone_number": "715-203-1305",
            "fax_number": "866-906-0578"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 INDEPENDENCE LN",
            "city": "WAUSAU",
            "state": "WI",
            "postal_code": "544035197",
            "telephone_number": "715-203-1305",
            "fax_number": "866-906-0578"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUBLIK",
        "first_name": "JAN",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-26",
        "last_updated": "2011-04-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "050499-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INSURANCE IDENTIFIER",
            "identifier": "161762514",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INSURANCE IDENTIFIER",
            "identifier": "161462496",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS IDENTIFIER",
            "identifier": "7961",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• James V Bruno, MD
• Susan R Brust, PSYCH NP, CNS
• Jennifer Brydson, CRNA
• Casey Jo Bube, APNP
• Anita Kaye Bublik-Anderson, M.D.
• Andrew Charles Buchl, MD
• Emma Janke Buckli, RN
• Barbara E Budimlija, PA
• Luke J. Budleski, D.O.
• Carrie Mae Budnick, LPN

• General Practice Dentistry in Wausau, WI
• Providers in Wausau, WI by specialty
• General Practice Dentistry in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.