NPIMap

Organization Active NPI

Andrew J. Schroettner, MDSC

  • Psychiatry Physician
  • Oconomowoc, WI
National Provider Identifier
1790992170
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
34568 Issued in WI
Legal business name
ANDREW J. SCHROETTNER, MDSC
Practice address
888 Thackeray TRL
Suite 211
Oconomowoc, WI 53066-4342
Phone
(262) 567-1122
Fax
(262) 567-1481
NPI assigned
May 16, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Andrew J Schroettner, MDNPI 1043245459
Title
Owner
Phone
(262) 567-1122

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2084P0800X 34568 WI Primary

Addresses

Primary practice location

888 Thackeray TRL
Suite 211
Oconomowoc, WI 53066-4342

Mailing address

888 Thackeray TRL
Suite 211
Oconomowoc, WI 53066-4342
Phone (262) 567-1122

Other identifiers 1

IdentifierTypeStateIssuer
31941000MedicaidWI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20071107000711 WI Part B Supplier - Clinic/Group Practice 7416044474 Receives reassigned benefits from 1 practitioner
Practice locations: Oconomowoc, WI

National Provider Directory

National Provider Directory

Locations

888 Thackeray Trl
Ste 211
Oconomowoc, WI 53066
Phone (262) 567-1122

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1179273600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1790992170",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "888 THACKERAY TRL",
            "address_2": "SUITE 211",
            "city": "OCONOMOWOC",
            "state": "WI",
            "postal_code": "530664342",
            "telephone_number": "262-567-1122",
            "fax_number": "262-567-1481"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "888 THACKERAY TRL",
            "address_2": "SUITE 211",
            "city": "OCONOMOWOC",
            "state": "WI",
            "postal_code": "530664342",
            "telephone_number": "262-567-1122",
            "fax_number": "262-567-1481"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANDREW J. SCHROETTNER, MDSC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-16",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SCHROETTNER",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "262-567-1122",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "WI",
            "license": "34568",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "31941000",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Oconomowoc, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.