Active NPI
John R Kregenow, DDS
- Dentist
- Wausau, WI
National Provider Identifier
1740205137
On this page
OIG exclusion record
The HHS Office of Inspector General’s List of Excluded Individuals/Entities (LEIE) contains a record with this NPI:
- Section 1128b(4) exclusion effective Jan 20, 2016.
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 5002132-015
- Practice address
- 1810 N 2ND St
Wausau, WI 54403 - Phone
- (715) 848-4884
- Fax
- (715) 845-5385
- NPI assigned
- Jul 13, 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 |
|---|---|---|---|---|
| Dentist | 122300000X | 5002132-015 | WI | Primary |
Addresses
Primary practice location
1810 N 2ND St
Wausau, WI 54403
Mailing address
1810 N 2ND St
Wausau, WI 54403
Phone (715) 848-4884
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 33375000 | 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)
- Not enrolled
- HHS exclusion list flag
- Flagged The directory lists this NPI on an HHS exclusion list.
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5002132-015 | WI | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152748800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1740205137",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1810 N 2ND ST",
"city": "WAUSAU",
"state": "WI",
"postal_code": "54403",
"telephone_number": "715-848-4884",
"fax_number": "715-845-5385"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1810 N 2ND ST",
"city": "WAUSAU",
"state": "WI",
"postal_code": "54403",
"telephone_number": "715-848-4884",
"fax_number": "715-845-5385"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KREGENOW",
"first_name": "JOHN",
"middle_name": "R",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-13",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "WI",
"license": "5002132-015",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "33375000",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Wausau, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.