Active NPI
Renee A Staehling, MD
- Family Medicine Physician
- Plymouth, WI
National Provider Identifier
1841256641
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 34889
- Practice address
- 515 E Mill St.
Plymouth, WI 53073-1807 - Phone
- (920) 892-4311
- Fax
- (920) 893-5978
- NPI assigned
- Apr 21, 2006
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 34889 | WI | Primary |
Addresses
Primary practice location
515 E Mill St.
Plymouth, WI 53073-1807
Mailing address
4425 N Port Washington Rd
Attn: Csmcp Clinic Credentialing
Glendale, WI 53212-1082
Phone (920) 892-4311
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 31997100 | Medicaid | WI |
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 Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1145577600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1339459200000",
"number": "1841256641",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4425 N PORT WASHINGTON RD",
"address_2": "ATTN: CSMCP CLINIC CREDENTIALING",
"city": "GLENDALE",
"state": "WI",
"postal_code": "532121082",
"telephone_number": "920-892-4311",
"fax_number": "920-893-5978"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "515 E MILL ST.",
"city": "PLYMOUTH",
"state": "WI",
"postal_code": "530731807",
"telephone_number": "920-892-4311",
"fax_number": "920-893-5978"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STAEHLING",
"first_name": "RENEE",
"middle_name": "A",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-04-21",
"last_updated": "2012-06-12",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "WI",
"license": "34889",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "31997100",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Plymouth, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.