Individual provider Active NPI

John Martin Hosten, DC

  • Sports Physician Chiropractor
  • Green Bay, WI
National Provider Identifier
1861464638
Registry record updated Jun 4, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Physician ChiropractorTaxonomy code 111NS0005X
License
5347-12 Issued in WI
Practice address
721 Cardinal LN Ste 100
Green Bay, WI 54313-3216
Phone
(920) 434-2221
Fax
(920) 434-2483
NPI assigned
Feb 6, 2006
Last updated
Jun 4, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 4, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 038010367 IL
Sports Physician Chiropractor 111NS0005X 5347-12 WI Primary

Addresses

Primary practice location

721 Cardinal LN Ste 100
Green Bay, WI 54313-3216

Mailing address

721 Cardinal LN Ste 100
Green Bay, WI 54313-3216
Phone (920) 434-2221

Other identifiers 1

IdentifierTypeStateIssuer
038020367MedicaidIL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050701000303 IL Practitioner - Chiropractic 0840236634 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
038010367ILMDChiropractor
5347-12WIMDSports Physician Chiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Bannockburn Chiropractic & Sports Injury Center PC Chiropractor CurrentSince Sep 1, 2019 Accepting new patients
Howard Chiropractic Clinic, S.C. CurrentSince Jun 9, 2024 Accepting new patients
Borre Chiropractic, LTD. Chiropractor Past Accepting new patients
Employment Health Services, LLC PastSince Jun 9, 2024 Accepting new patients

Locations

2101 Waukegan Rd
Ste 100
Bannockburn, IL 60015
Phone (847) 236-1194

721 Cardinal Ln
Ste 100
Green Bay, WI 54313
Phone (920) 434-2221

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1139184000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717459200000",
    "number": "1861464638",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "721 CARDINAL LN STE 100",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543133216",
            "telephone_number": "920-434-2221",
            "fax_number": "920-434-2483"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "721 CARDINAL LN STE 100",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543133216",
            "telephone_number": "920-434-2221",
            "fax_number": "920-434-2483"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOSTEN",
        "first_name": "JOHN",
        "middle_name": "MARTIN",
        "name_prefix": "Dr.",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-06",
        "last_updated": "2024-06-04",
        "certification_date": "2024-06-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "IL",
            "license": "038010367",
            "primary": false
        },
        {
            "code": "111NS0005X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Sports Physician",
            "state": "WI",
            "license": "5347-12",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "038020367",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Green Bay, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.