Individual provider Active NPI

Corey J Zeller, MD

  • Family Medicine Physician
  • Wild Rose, WI
National Provider Identifier
1710955299
Registry record updated Apr 29, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
47141 Issued in WI
Practice address
701 Grove Ave
Wild Rose, WI 54984-6901
Phone
(920) 622-5560
NPI assigned
Mar 9, 2006
Last updated
Apr 29, 2014By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 29, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 47141 WI Primary

Addresses

Primary practice location

701 Grove Ave
Wild Rose, WI 54984-6901

Mailing address

701 Grove Ave
Wild Rose, WI 54984-6901
Phone (920) 622-5560

Other identifiers 1

IdentifierTypeStateIssuer
207Q00000XMedicaidWI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041214000669 WI Practitioner - Family Practice 8123085883 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Wisconsin School of Medicine, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Emergency Medicine Specialists SCGroup PAC ID 8729975461, 220 clinicians

Practice addresses (Care Compare)

101 Main St
Neenah, WI 54956-2570
Phone (920) 727-4200

1855 S Koeller St
Oshkosh, WI 54902-6186
Phone (920) 223-7000

3329 N Richard St
Appleton, WI 54911-1063
Phone (920) 380-2715

5000 W Chambers St
Milwaukee, WI 53210-1650
Phone (414) 447-2000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
47141WIMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Thedacare, Incorporated Family Medicine CurrentSince Feb 1, 2016 Accepting new patients
Emergency Medicine Specialists, S.C. CurrentSince Apr 1, 2025 Accepting new patients

Locations

3329 N Richmond St
Appleton, WI 54911
Phone (920) 380-2715

225 Memorial Dr
Berlin, WI 54923
Phone (920) 361-1313

5000 W Chambers St
Milwaukee, WI 53210
Phone (414) 447-2089

1405 Mill St
New London, WI 54961
Phone (920) 531-2000

1855 S Koeller St
Oshkosh, WI 54902
Phone (920) 223-7010

710 Riverside Dr
Waupaca, WI 54981
Phone (715) 256-3000

10625 W North Ave
Ste 101
Wauwatosa, WI 53226
Phone (414) 858-2200

601 Grove Ave
Wild Rose, WI 54984
Phone (920) 361-5907

701 Grove Ave
Wild Rose, WI 54984
Phone (920) 361-5340

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1141862400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1398729600000",
    "number": "1710955299",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "701 GROVE AVE",
            "city": "WILD ROSE",
            "state": "WI",
            "postal_code": "549846901",
            "telephone_number": "920-622-5560"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 GROVE AVE",
            "city": "WILD ROSE",
            "state": "WI",
            "postal_code": "549846901",
            "telephone_number": "920-622-5560"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ZELLER",
        "first_name": "COREY",
        "middle_name": "J",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-09",
        "last_updated": "2014-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "47141",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "207Q00000X",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wild Rose, WI

Sources for this page

Verify at the official NPI Registry.