NPIMap

Individual provider Active NPI

Diane M Anderson, FNPC

  • Nurse Practitioner
  • Medford, WI
National Provider Identifier
1801875364
Registry record updated May 15, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
1505-033 Issued in WI
Practice address
143 South Gibson Street
Medford, WI 54451-1622
Phone
(715) 748-2121
Fax
(715) 748-7590
NPI assigned
Jan 12, 2006
Last updated
May 15, 2012By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 15, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 1505-033 WI Primary

Addresses

Primary practice location

143 South Gibson Street
Medford, WI 54451-1622

Mailing address

143 South Gibson Street
Medford, WI 54451-1622
Phone (715) 748-2121

Other identifiers 1

IdentifierTypeStateIssuer
43896800MedicaidWI

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
I20031223000559 WI Practitioner - Nurse Practitioner 9739087024 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Aspirus Medford Hospital and Clinics IncGroup PAC ID 5799688602, shared by 9 NPIs, 126 clinicians

Practice addresses (Care Compare)

135 S Gibson St
Medford, WI 54451-1622
Phone (715) 748-8100

143 S Gibson St
Medford, WI 54451-1622
Phone (715) 748-8100

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Quality
97.16
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1505-033WIMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Aspirus Medford Hospital & Clinics, Inc. Current Accepting new patients
Aspirus Medford Hospital & Clinics, Inc. CurrentSince Mar 1, 2020 Accepting new patients
Aspirus Medford Hospital & Clinics, Inc. Current Accepting new patients
Aspirus Medford Hospital & Clinics, Inc. CurrentSince Mar 1, 2020 Accepting new patients

Locations

29980 Network Pl
Chicago, IL 60673

135 S Gibson St
Medford, WI 54451
Phone (715) 748-8100

143 S Gibson St
Medford, WI 54451
Phone (715) 748-2121

500 Wind Ridge Dr
Wausau, WI 54401

Ownership & related parties

All facility ownership & control disclosures 13

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Aspirus Stanley HospitalStanley, WI, CCN 521311 Hospital Corporate Director Oct 1, 2022
Aspirus Stanley HospitalStanley, WI, CCN 52Z311 Hospital Corporate Director Oct 1, 2022
Aspirus Medford Hospital & Clinics IncMedford, WI, CCN 521324 Hospital Corporate Director Oct 1, 2022
Aspirus Medford Hospital & Clinics IncMedford, WI, CCN 52Z324 Hospital Corporate Director Oct 1, 2022
Aspirus Care & Rehab - MedfordMedford, WI, CCN 525641 Skilled nursing facility Corporate Director Oct 1, 2022
Aspirus Thorp ClinicThorp, WI, CCN 528519 Rural health clinic Corporate Director Oct 1, 2022
Aspirus Owen ClinicOwen, WI, CCN 528518 Rural health clinic Corporate Director Oct 1, 2022
Aspirus Stanley ClinicStanley, WI, CCN 528521 Rural health clinic Corporate Director Oct 1, 2022
Aspirus Gilman ClinicGilman, WI, CCN 528535 Rural health clinic Corporate Director Oct 1, 2022
Aspirus Phillips ClinicPhillips, WI, CCN 528537 Rural health clinic Corporate Director Oct 1, 2022
Aspirus Prentice ClinicPrentice, WI, CCN 528536 Rural health clinic Corporate Director Oct 1, 2022
Aspirus Medford ClinicMedford, WI, CCN 528559 Rural health clinic Corporate Director Oct 1, 2022
Aspirus Athens ClinicAthens, WI, CCN 528583 Rural health clinic Corporate Director Oct 1, 2022

Owned or controlled facilities with NPI records 17

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

View all 17

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 22

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

View all 22

NPI Registry JSON

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

{
    "created_epoch": "1137024000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1337040000000",
    "number": "1801875364",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "143 SOUTH GIBSON STREET",
            "city": "MEDFORD",
            "state": "WI",
            "postal_code": "544511622",
            "telephone_number": "715-748-2121",
            "fax_number": "715-847-2465"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "143 SOUTH GIBSON STREET",
            "city": "MEDFORD",
            "state": "WI",
            "postal_code": "544511622",
            "telephone_number": "715-748-2121",
            "fax_number": "715-748-7590"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDERSON",
        "first_name": "DIANE",
        "middle_name": "M",
        "name_prefix": "Mrs.",
        "credential": "FNPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-01-12",
        "last_updated": "2012-05-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "WI",
            "license": "1505-033",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "43896800",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Medford, WI

Sources for this page

Verify at the official NPI Registry.