Peter Hummel Ackell, MD
Individual provider Active NPI Interventional Cardiology Physician · Appleton, WI
NPI 1710937115 · NPPES record last updated Jul 31, 2019
Key facts
- NPI
- 1710937115
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Interventional Cardiology Physician 207RI0011X
- License
- 29907-020 (WI)
- Practice address
- 5045 W Grande Market Dr
Appleton, WI 54913-8517 - Phone
- (920) 886-9380
- Fax
- (920) 886-9381
- NPI assigned
- May 10, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
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 |
|---|---|---|---|---|
| I20050222000239 | WI | Practitioner - Interventional Cardiology |
1456264464 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 29907-020 | WI | MD | Cardiovascular Disease Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Heart and Vascular of Wisconsin, SC | Cardiovascular Disease | Current |
Accepting new patients |
Locations
5045 W Grande Market Dr
Appleton, WI 54913
Phone (920) 747-0505
1818 N Meade St
Appleton, WI 54911
Phone (920) 731-4101
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Cardiovascular Disease Physician | 207RC0000X | 29907-020 | WI | |
| Internal Medicine Physician | 207R00000X | 29907-020 | WI | |
| Interventional Cardiology Physician | 207RI0011X | 29907-020 | WI | Yes |
Addresses
Primary practice location
5045 W Grande Market Dr
Appleton, WI 54913-8517
Mailing address
Bin 88040
Milwaukee, WI 53288-0040
Phone (902) 886-9380
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 31467300 | Medicaid | WI |
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All providers in Appleton, WI · Interventional Cardiology 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 Jul 31, 2019. 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).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.