NPIMap

Individual provider Active NPI

Shawn P Hennigan, MD

  • Orthopaedic Surgery Physician
  • Appleton, WI
National Provider Identifier
1821026790
Registry record updated Apr 18, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
License
45657 Issued in WI
Practice address
2323 N Casaloma Dr
Appleton, WI 54913-8284
Phone
(920) 730-8833
NPI assigned
Jun 29, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 18, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery Physician 207X00000X 45657 WI Primary

Addresses

Primary practice location

2323 N Casaloma Dr
Appleton, WI 54913-8284

Mailing address

3467 Country Winds CT
Green Bay, WI 54311-6906
Phone (920) 639-7751

Other identifiers 6

IdentifierTypeStateIssuer
34380900MedicaidWI
P00011123OtherWIRAILROAD
104507348MedicaidMI
104641130MedicaidMI
104788310MedicaidMI
104705943MedicaidMI

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
I20040414000163 WI Practitioner - Orthopedic Surgery 7911991724 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Orthopedic Surgery
Education
Temple University School of Medicine, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Hand to Shoulder Center of Wisconsin, LTD.Group PAC ID 6901884337, 34 clinicians

Practice addresses (Care Compare)

2323 N Casaloma Dr
Appleton, WI 54913-8284
Phone (920) 730-8833

Hospital & facility affiliations

  • Thedacare Regional Medical Center - Appleton Inc Hospital, Appleton, WI, CCN 520160
  • Door County Medical Center Hospital, Sturgeon Bay, WI, CCN 521358
  • Ascension NE Wisconsin - St Elizabeth Campus Hospital, Appleton, WI, CCN 520009
  • Aurora Medical Ctr Oshkosh Hospital, Oshkosh, WI, CCN 520198
  • Thedacare Medical Center - Berlin Inc Hospital, Berlin, WI, CCN 521355

Procedures performed for Medicare patients

ProcedureNumber of procedures
Upper limb (arm) arthroscopy (minimally invasive joint repair)49

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
45657WIMDOrthopaedic Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Baycare Clinic LLP Orthopaedic Surgery CurrentSince Jul 15, 2003 Accepting new patients
Baycare Clinic LLP CurrentSince Jul 15, 2003 Accepting new patients
Hand to Shoulder Center of Wisconsin, LTD. CurrentSince Mar 1, 2020 Accepting new patients
Hand to Shoulder Center of Wisconsin, LTD. CurrentSince Mar 1, 2020 Accepting new patients

Locations

2323 N Casaloma Dr
Appleton, WI 54913

2733 S Ridge Rd
Green Bay, WI 54304
Phone (920) 497-6200

164 N Broadway
Green Bay, WI 54303
Phone (920) 965-4055

2581 Development Dr
Green Bay, WI 54311
Phone (920) 347-0400

1551 Park Pl
Green Bay, WI 54304
Phone (773) 551-9490

1035 Kepler Dr
Green Bay, WI 54311

1160 Kepler Dr
Green Bay, WI 54311
Phone (920) 288-5400

601 Reed Ave
Manitowoc, WI 54220
Phone (920) 682-8841

1910 Alabama St
Sturgeon Bay, WI 54235
Phone (920) 746-7200

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 15

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

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1151539200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1587168000000",
    "number": "1821026790",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3467 COUNTRY WINDS CT",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543116906",
            "telephone_number": "920-639-7751"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2323 N CASALOMA DR",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549138284",
            "telephone_number": "920-730-8833"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENNIGAN",
        "first_name": "SHAWN",
        "middle_name": "P",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-29",
        "last_updated": "2020-04-18",
        "certification_date": "2020-04-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "WI",
            "license": "45657",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "34380900",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD",
            "identifier": "P00011123",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "104507348",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "104641130",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "104788310",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "104705943",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Appleton, WI

Sources for this page

Verify at the official NPI Registry.