Active NPI
Richard P Jennings, DO
- Otolaryngology Physician
- Stevens Point, WI
National Provider Identifier
1831177633
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Otolaryngology Physician
- License
- 29143
- Practice address
- 824 Illinois Ave
Stevens Point, WI 54481-3112 - Phone
- (715) 342-7500
- NPI assigned
- Jan 3, 2006
- 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 |
|---|---|---|---|---|
| Otolaryngology Physician | 207Y00000X | 29143 | WI | Primary |
Addresses
Primary practice location
824 Illinois Ave
Stevens Point, WI 54481-3112
Mailing address
824 Illinois Ave
Stevens Point, WI 54481-3112
Phone (715) 342-7500
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 30042200 | Medicaid | WI | |
| 540756 | Other | WI | DEAN HEALTH |
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 Osteopathy
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1136246400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1363046400000",
"number": "1831177633",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "824 ILLINOIS AVE",
"city": "STEVENS POINT",
"state": "WI",
"postal_code": "544813112",
"telephone_number": "715-342-7500"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "824 ILLINOIS AVE",
"city": "STEVENS POINT",
"state": "WI",
"postal_code": "544813112",
"telephone_number": "715-342-7500"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JENNINGS",
"first_name": "RICHARD",
"middle_name": "P",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-01-03",
"last_updated": "2013-03-12",
"status": "A"
},
"taxonomies": [
{
"code": "207Y00000X",
"taxonomy_group": "",
"desc": "Otolaryngology",
"state": "WI",
"license": "29143",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "30042200",
"state": "WI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DEAN HEALTH",
"identifier": "540756",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Stevens Point, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.