Active NPI
Patricia M Demery, MD
- Family Medicine Physician
- Kaukauna, WI
National Provider Identifier
1902863442
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 32560-020
- Practice address
- N9554 Highline Rd
Kaukauna, WI 54130-8502 - Phone
- (920) 277-9716
- Fax
- (920) 766-1415
- NPI assigned
- Apr 27, 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | 32560-020 | WI | |
| Family Medicine Physician | 207Q00000X | 32560-020 | WI | Primary |
Addresses
Primary practice location
N9554 Highline Rd
Kaukauna, WI 54130-8502
Mailing address
N9554 Highline Rd
Kaukauna, WI 54130-8502
Phone (920) 277-9716
Other practice location 1
N9554 Highline Rd
Kaukauna, WI 54130-8502
Phone (920) 277-9716
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 31750000 | Medicaid | WI |
Other names 1
- Patricia M O'Leary
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 32560-020 | WI | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1146096000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1641427200000",
"number": "1902863442",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "N9554 HIGHLINE RD",
"city": "KAUKAUNA",
"state": "WI",
"postal_code": "541308502",
"telephone_number": "920-277-9716"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "N9554 HIGHLINE RD",
"city": "KAUKAUNA",
"state": "WI",
"postal_code": "541308502",
"telephone_number": "920-277-9716",
"fax_number": "920-766-1415"
}
],
"practiceLocations": [
{
"address_1": "N9554 Highline Rd",
"address_purpose": "LOCATION",
"city": "Kaukauna",
"state": "WI",
"postal_code": "541308502",
"country_code": "US",
"telephone_number": "920-277-9716",
"fax_number": "920-766-1415",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "DEMERY",
"first_name": "PATRICIA",
"middle_name": "M",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-04-27",
"last_updated": "2022-01-06",
"certification_date": "2022-01-06",
"status": "A"
},
"taxonomies": [
{
"code": "207P00000X",
"taxonomy_group": "",
"desc": "Emergency Medicine",
"state": "WI",
"license": "32560-020",
"primary": false
},
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "WI",
"license": "32560-020",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "31750000",
"state": "WI"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "PATRICIA",
"last_name": "O'LEARY",
"middle_name": "M",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Kaukauna, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.