Active NPI
Edgardo C Jiongco, MD
- Diagnostic Radiology Physician
- Fort Atkinson, WI
National Provider Identifier
1720057771
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Diagnostic Radiology Physician
- License
- 20514
- Practice address
- 601 Handeyside Lane
Fort Atkinson, WI 53538 - Phone
- (920) 563-5544
- Fax
- (608) 833-6932
- NPI assigned
- Mar 14, 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 |
|---|---|---|---|---|
| Diagnostic Radiology Physician | 2085R0202X | 20514 | WI | Primary |
Addresses
Primary practice location
601 Handeyside Lane
Fort Atkinson, WI 53538
Mailing address
8007 Excelsior Drive
Madison, WI 53717
Phone (608) 829-5238
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 31094800 | 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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20514 | WI | MD | Diagnostic Radiology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| University of Wisconsin Medical Foundation Inc | Past | Accepting new patients | |
| University of Wisconsin Medical Foundation, Inc | Past | Accepting new patients | |
| Madison Institute of Neurological Disorders, SC | Past | Accepting new patients | |
| Dean Health Systems, Inc, | Past | Accepting new patients |
Organizations & group practices 4
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.
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-
- Durable Medical Equipment & Medical Supplies
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- NPI 1174583363
-
- Health Educator
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- NPI 1487414082
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1142294400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1203292800000",
"number": "1720057771",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8007 EXCELSIOR DRIVE",
"city": "MADISON",
"state": "WI",
"postal_code": "53717",
"telephone_number": "608-829-5238",
"fax_number": "608-833-6932"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "601 HANDEYSIDE LANE",
"city": "FORT ATKINSON",
"state": "WI",
"postal_code": "53538",
"telephone_number": "920-563-5544",
"fax_number": "608-833-6932"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JIONGCO",
"first_name": "EDGARDO",
"middle_name": "C",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-03-14",
"last_updated": "2008-02-18",
"status": "A"
},
"taxonomies": [
{
"code": "2085R0202X",
"taxonomy_group": "",
"desc": "Radiology, Diagnostic Radiology",
"state": "WI",
"license": "20514",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "31094800",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fort Atkinson, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.