NPIMap

Individual provider Active NPI

Kari Sheldon, MD

  • Family Medicine Physician
  • Black Creek, WI
National Provider Identifier
1891722435
Registry record updated Nov 10, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
39110 Issued in WI
Practice address
400 S Maple St
Black Creek, WI 54106-9787
Phone
(920) 984-3361
NPI assigned
Jun 27, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 10, 2014

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 39110 WI Primary

Addresses

Primary practice location

400 S Maple St
Black Creek, WI 54106-9787

Mailing address

PO Box 8003
Appleton, WI 54912-8003
Phone (920) 996-3298

Other identifiers 1

IdentifierTypeStateIssuer
32606000MedicaidWI

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
I20080513000556 WI Practitioner - Family Practice 3870662133 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Wisconsin School of Medicine, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Thedacare, IncorporatedGroup PAC ID 1759294887, 654 clinicians

Practice addresses (Care Compare)

2500 E Capital Dr
Appleton, WI 54911-8735

3 Neenah Ctr
Neenah, WI 54956-3070

3925 N Gateway Dr
Appleton, WI 54913-7863
Phone (820) 702-6477

400 S Maple St
Black Creek, WI 54106-9787
Phone (920) 984-3361

4480 W Spencer St
Appleton, WI 54915
Phone (920) 738-4800

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
39110WIMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Thedacare Regional Medical Center-Neenah, Inc. CurrentSince Mar 1, 2020 Accepting new patients
Thedacare, Incorporated Family Medicine CurrentSince Jan 9, 2007 Accepting new patients
Thedacare Medical Center - Berlin, Inc. CurrentSince Mar 1, 2020 Accepting new patients
Thedacare Regional Medical Center-Neenah, Inc. CurrentSince Mar 1, 2020 Accepting new patients
Thedacare Medical Center - Shawano, Inc. CurrentSince Mar 1, 2020 Accepting new patients
Thedacare Medical Center - Berlin, Inc. CurrentSince Mar 1, 2020 Accepting new patients
Thedacare Medical Center - Shawano, Inc. CurrentSince Mar 1, 2020 Accepting new patients

Locations

1818 N Meade St
Appleton, WI 54911
Phone (920) 731-4101

4480 W Spencer St
Appleton, WI 54914
Phone (920) 738-4800

225 Memorial Dr
Berlin, WI 54923
Phone (920) 361-1313

400 S Maple St
Black Creek, WI 54106
Phone (920) 984-3361

130 2nd St
Neenah, WI 54956
Phone (920) 729-2063

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

100 Cty Road B
Shawano, WI 54166
Phone (715) 524-2161

Interoperability endpoints

  • Direct secure messaging: ksheldon14443@direct.thedacare.org

Organizations & group practices 7

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.

Hospital & facility affiliations 16

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

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1151366400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1415577600000",
    "number": "1891722435",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 8003",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549128003",
            "telephone_number": "920-996-3298",
            "fax_number": "920-738-5787"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 S MAPLE ST",
            "city": "BLACK CREEK",
            "state": "WI",
            "postal_code": "541069787",
            "telephone_number": "920-984-3361"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHELDON",
        "first_name": "KARI",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-27",
        "last_updated": "2014-11-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "39110",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "32606000",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Black Creek, WI

Sources for this page

Verify at the official NPI Registry.