NPIMap

Individual provider Active NPI

Guoqing Song, PA-C

  • Surgical Physician Assistant
  • Appleton, WI
National Provider Identifier
1801247176
Registry record updated Sep 1, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
4030 Issued in WI
Practice address
2400 E Capitol Dr
Appleton, WI 54911-8728
Phone
(920) 831-5050
NPI assigned
Jun 28, 2016
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 1, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X 085-005846 IL
Surgical Physician Assistant 363AS0400X 4030 WI Primary

Addresses

Primary practice location

2400 E Capitol Dr
Appleton, WI 54911-8728

Mailing address

3 Neenah Ctr
Neenah, WI 54956-3070
Phone (920) 831-5050

Other practice location 1

2000 Lake Ave
Woodstock, IL 60098-7401
Phone (815) 337-7100

Other practice location 2

820 E Grant St
Appleton, WI 54911-3483
Phone (920) 831-5050

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170919004181 WI Practitioner - Physician Assistant 6709172364 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
University of Wisconsin School of Medicine, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Thedacare, IncorporatedGroup PAC ID 1759294887, 654 clinicians

Practice addresses (Care Compare)

2400 E Capitol Dr
Appleton, WI 54911-8728
Phone (920) 720-2300

3 Neenah Ctr
Neenah, WI 54956-3070

4480 W Spencer St
Appleton, WI 54915
Phone (920) 738-4800

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
085-005846ILMDSurgical Physician Assistant
4030WIMDSurgical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Thedacare, Incorporated CurrentSince Apr 1, 2022 Accepting new patients
Thedacare, Incorporated CurrentSince Apr 1, 2022 Accepting new patients
Beaver Dam Community Hospitals Inc CurrentSince Aug 15, 2017 Accepting new patients
Thedacare Medical Center - Berlin, Inc. Past Accepting new patients

Locations

2400 E Capitol Dr
Appleton, WI 54911
Phone (920) 731-4101

4480 W Spencer St
Appleton, WI 54914
Phone (920) 738-4800

705 S University Ave
Beaver Dam, WI 53916
Phone (920) 885-6090

3 Neenah Ctr
Neenah, WI 54956
Phone (920) 454-4229

1405 Mill St
New London, WI 54961
Phone (920) 531-2000

600 N Westhaven Dr
Oshkosh, WI 54904
Phone (920) 237-5000

Interoperability endpoints

  • Direct secure messaging: gsong320677@direct.thedacare.org

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.

Hospital & facility affiliations 12

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1467072000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661990400000",
    "number": "1801247176",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3 NEENAH CTR",
            "city": "NEENAH",
            "state": "WI",
            "postal_code": "549563070",
            "telephone_number": "920-831-5050",
            "fax_number": "920-738-6507"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2400 E CAPITOL DR",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549118728",
            "telephone_number": "920-831-5050"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2000 Lake Ave",
            "address_purpose": "LOCATION",
            "city": "Woodstock",
            "state": "IL",
            "postal_code": "600987401",
            "country_code": "US",
            "telephone_number": "815-337-7100",
            "fax_number": "815-337-4793",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "820 E Grant St",
            "address_purpose": "LOCATION",
            "city": "Appleton",
            "state": "WI",
            "postal_code": "549113483",
            "country_code": "US",
            "telephone_number": "920-831-5050",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SONG",
        "first_name": "GUOQING",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-06-28",
        "last_updated": "2022-09-01",
        "certification_date": "2022-09-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "IL",
            "license": "085-005846",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "WI",
            "license": "4030",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Appleton, WI

Sources for this page

Verify at the official NPI Registry.