NPIMap

Individual provider Active NPI

Steven A Goedderz, MD

  • Family Medicine Physician
  • New London, WI
National Provider Identifier
1841226818
Registry record updated Oct 18, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
38372 Issued in WI
Practice address
1420 Algoma St
New London, WI 54961-2104
Phone
(920) 982-8300
NPI assigned
Jun 23, 2006
Last updated
Oct 18, 2012By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 18, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 38372 WI Primary

Addresses

Primary practice location

1420 Algoma St
New London, WI 54961-2104

Mailing address

1420 Algoma St
New London, WI 54961-2104
Phone (920) 982-8300

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
I20040327000139 WI Practitioner - Family Practice 0840182473 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1984
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1420 Algoma St
New London, WI 54961-2104
Phone (920) 982-8300

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of nail tissue1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
38372WIMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Ascension Medical Group-Fox Valley Wisconsin, Inc CurrentSince Oct 1, 2012 Accepting new patients
Ascension Medical Group-Fox Valley Wisconsin, Inc CurrentSince Oct 1, 2012 Accepting new patients
Radiology Associates of Appleton, S.C. Past Accepting new patients

Locations

1501 S Madison St
Appleton, WI 54915
Phone (920) 730-4435

1405 Mill St
New London, WI 54961
Phone (920) 531-2000

1420 Algoma St
New London, WI 54961
Phone (920) 828-8300

2700 W 9th Ave
Oshkosh, WI 54904
Phone (920) 223-0220

190 Grand Seasons Dr
Waupaca, WI 54981
Phone (715) 258-3401

800 Riverside Dr
Waupaca, WI 54981
Phone (715) 258-1000

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 9

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

NPI Registry JSON

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

{
    "created_epoch": "1151020800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1350518400000",
    "number": "1841226818",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1420 ALGOMA ST",
            "city": "NEW LONDON",
            "state": "WI",
            "postal_code": "549612104",
            "telephone_number": "920-982-8300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1420 ALGOMA ST",
            "city": "NEW LONDON",
            "state": "WI",
            "postal_code": "549612104",
            "telephone_number": "920-982-8300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOEDDERZ",
        "first_name": "STEVEN",
        "middle_name": "A",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-23",
        "last_updated": "2012-10-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "38372",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New London, WI

Sources for this page

Verify at the official NPI Registry.