John S Pallin, M.D.

Primary specialty

SpecialistTaxonomy code 174400000X

License

29659020 Issued in WI

Practice address

10117 74TH St
Suite 150
Kenosha, WI 53142-7533

Phone

(262) 697-7770

Fax

(262) 697-7771

NPI assigned

Jan 2, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

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

Specialty

Diagnostic Radiology

Education

University of Wisconsin School of Medicine, 1980

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Kenosha Radiology Center LLC.

  • Radiology Clinic/Center
  • Kenosha, WI
  • NPI 1770540130
  NPD (past) Authorized official
• Stat Anesthesia Specialists, LTD.

  • Anesthesiology Physician
  • Bremen, IN
  • NPI 1992754089
  NPD (past)

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

{
    "created_epoch": "1167696000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1790842631",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10117 74TH ST",
            "address_2": "SUITE 150",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531427533",
            "telephone_number": "262-697-7770",
            "fax_number": "262-697-7771"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10117 74TH ST",
            "address_2": "SUITE 150",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531427533",
            "telephone_number": "262-697-7770",
            "fax_number": "262-697-7771"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PALLIN",
        "first_name": "JOHN",
        "middle_name": "S",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-02",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "WI",
            "license": "29659020",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "21255800",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jennifer Joli Page
• Pain Centers of Wisconsin - Kenosha, LLC
• Pain Physicians of Wisconsin, SC
• Pain Physicians of Wisconsin, SC
• Jane Cary Pallin, M.D.
• Kristen A Palmer, LCSW
• Damar Palomares, RN
• Tiffany Panasewicz, LPC
• Susan Marie Panger, LMFT LCSW
• Rachel Papp

• Specialist in Kenosha, WI
• Providers in Kenosha, WI by specialty
• Specialist in Wisconsin

• 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; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.