Active NPI
Nancy Jean Homburg, M.D.
- Family Medicine Physician
- Appleton, WI
National Provider Identifier
1720073208
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 19584
- Practice address
- 3329 N Richmond St
Appleton, WI 54911 - Phone
- (920) 380-2719
- Fax
- (920) 380-2755
- NPI assigned
- Sep 12, 2005
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 19584 | WI | Primary |
Addresses
Primary practice location
3329 N Richmond St
Appleton, WI 54911
Mailing address
3329 N Richmond St
Appleton, WI 54911
Phone (920) 380-2719
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| AH6655370 | Other | BNDD | |
| 30158000 | 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 |
|---|---|---|---|
| 19584 | WI | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1126483200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1346371200000",
"number": "1720073208",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3329 N RICHMOND ST",
"city": "APPLETON",
"state": "WI",
"postal_code": "54911",
"telephone_number": "920-380-2719",
"fax_number": "920-380-2755"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3329 N RICHMOND ST",
"city": "APPLETON",
"state": "WI",
"postal_code": "54911",
"telephone_number": "920-380-2719",
"fax_number": "920-380-2755"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HOMBURG",
"first_name": "NANCY",
"middle_name": "JEAN",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-09-12",
"last_updated": "2012-08-31",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "WI",
"license": "19584",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BNDD",
"identifier": "AH6655370",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "30158000",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Appleton, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.