NPIMap

Organization Active NPI

Pediatrix Medical Group of Wisconsin, SC

  • Neonatal-Perinatal Medicine Physician
  • Appleton, WI
National Provider Identifier
1821700857
Registry record updated Dec 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neonatal-Perinatal Medicine PhysicianTaxonomy code 2080N0001X
Legal business name
PEDIATRIX MEDICAL GROUP OF WISCONSIN, SC
Practice address
1506 S Oneida St
Appleton, WI 54915-1305
Phone
(920) 738-2000
NPI assigned
Dec 21, 2022
Last updated
Dec 21, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 21, 2022

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

Authorized official

Name
Dr. Delores M Gries, MD
Title
Director, President
Phone
(800) 243-3839

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X
Neonatal-Perinatal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2080N0001X Primary
Neonatal Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LN0000X

Addresses

Primary practice location

1506 S Oneida St
Appleton, WI 54915-1305

Mailing address

1301 Concord Ter
Sunrise, FL 33323-2843
Phone (800) 243-3839

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 16

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1671580800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1671580800000",
    "number": "1821700857",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1301 CONCORD TER",
            "city": "SUNRISE",
            "state": "FL",
            "postal_code": "333232843",
            "telephone_number": "800-243-3839"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1506 S ONEIDA ST",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549151305",
            "telephone_number": "920-738-2000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIX MEDICAL GROUP OF WISCONSIN, SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-12-21",
        "last_updated": "2022-12-21",
        "certification_date": "2022-12-21",
        "status": "A",
        "authorized_official_last_name": "GRIES",
        "authorized_official_first_name": "DELORES",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "DIRECTOR, PRESIDENT",
        "authorized_official_telephone_number": "800-243-3839",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2080N0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics, Neonatal-Perinatal Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LN0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Neonatal",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Appleton, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.