Active NPI
Stuart A Kosikowski, OD
- Optometrist
- Fond Du Lac, WI
National Provider Identifier
1831170141
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 2012
- Practice address
- 421 Camelot Dr
Fond Du Lac, WI 54935-4560 - Phone
- (920) 926-8472
- NPI assigned
- Nov 14, 2005
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Optometrist | 152W00000X | 2012 | WI | Primary |
Addresses
Primary practice location
421 Camelot Dr
Fond Du Lac, WI 54935-4560
Mailing address
420 E Division St
Fond Du Lac, WI 54935-4560
Phone (920) 926-8472
Other identifiers 6
| Identifier | Type | State | Issuer |
|---|---|---|---|
| WI01J4 | Other | WI | JOHN DEERE |
| 12565 | Other | WI | DEAN |
| 38525900 | Medicaid | WI | |
| 410029533 | Other | WI | RAILROAD MEDICARE |
| 39080723646 | Other | WI | UNITY |
| 501574 | Other | WV | TOUCHPOINT |
Electronic endpoints 2
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| FHIR URL | https://fhir.ssmhc.com/fhir/api/FHIR/DSTU2/ | Other | |
| Direct Messaging Address | skosikowski341937@direct-ehr-ssmhc.com | Direct |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2012 | WI | MD | Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Agnesian Healthcare, Inc | Current | Accepting new patients | |
| Agnesian Healthcare Inc | Current | Accepting new patients | |
| Agnesian Healthcare Inc | Optometrist | Current | Accepting new patients |
Locations
420 E Division St
Fond du Lac, WI 54935
Phone (920) 923-7400
421 Camelot Dr
Fond du Lac, WI 54935
Phone (920) 923-7940
Organizations & group practices 3
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.
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- General Acute Care Hospital
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- NPI 1346228541
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1131926400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1605657600000",
"number": "1831170141",
"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": "920-926-8472"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "421 CAMELOT DR",
"city": "FOND DU LAC",
"state": "WI",
"postal_code": "549354560",
"telephone_number": "920-926-8472"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOSIKOWSKI",
"first_name": "STUART",
"middle_name": "A",
"credential": "OD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-11-14",
"last_updated": "2020-11-18",
"certification_date": "2020-11-17",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "WI",
"license": "2012",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "JOHN DEERE",
"identifier": "WI01J4",
"state": "WI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DEAN",
"identifier": "12565",
"state": "WI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "38525900",
"state": "WI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "410029533",
"state": "WI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITY",
"identifier": "39080723646",
"state": "WI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TOUCHPOINT",
"identifier": "501574",
"state": "WV"
}
],
"endpoints": [
{
"endpointType": "FHIR",
"endpointTypeDescription": "FHIR URL",
"endpoint": "https://fhir.ssmhc.com/fhir/api/FHIR/DSTU2/",
"affiliation": "N",
"use": "OTHER",
"useDescription": "Other",
"useOtherDescription": "FHIR API",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "CCD",
"address_1": "421 Camelot Dr",
"city": "Fond du Lac",
"state": "WI",
"country_code": "US",
"postal_code": "549354560",
"country_name": "United States",
"address_type": "DOM"
},
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "skosikowski341937@direct-ehr-ssmhc.com",
"affiliation": "N",
"use": "DIRECT",
"useDescription": "Direct",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "skosikowski341937@direct-ehr-ssmhc.com",
"address_1": "421 Camelot Dr",
"city": "Fond du Lac",
"state": "WI",
"country_code": "US",
"postal_code": "549354560",
"country_name": "United States",
"address_type": "DOM"
}
],
"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 Nov 18, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.