Active NPI
Daisy I Santa, MD
- Pediatrics Physician
- Fond Du Lac, WI
National Provider Identifier
1811979701
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 34089
- Practice address
- 420 E Division St
Fond Du Lac, WI 54935-4560 - Phone
- (920) 926-8424
- NPI assigned
- Nov 16, 2005
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 34089 | WI | Primary |
Addresses
Primary practice location
420 E Division St
Fond Du Lac, WI 54935-4560
Mailing address
420 E Division St
Fond Du Lac, WI 54935-4560
Phone (920) 926-8340
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 31899500 | 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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 34089 | WI | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1132099200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1456876800000",
"number": "1811979701",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "420 E DIVISION ST",
"city": "FOND DU LAC",
"state": "WI",
"postal_code": "549354560",
"telephone_number": "920-926-8340",
"fax_number": "920-926-8370"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "420 E DIVISION ST",
"city": "FOND DU LAC",
"state": "WI",
"postal_code": "549354560",
"telephone_number": "920-926-8424"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SANTA",
"first_name": "DAISY",
"middle_name": "I",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-11-16",
"last_updated": "2016-03-02",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "WI",
"license": "34089",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "31899500",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fond Du Lac, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.