Active NPI
Samuel B Picone Jr., M.D.
- Surgery Physician
- Summit Lake, WI
National Provider Identifier
1942233630
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- 33904
- Practice address
- N9781 W Duck Lake Rd # Ktc130
Summit Lake, WI 54485-9629 - Phone
- (715) 443-4329
- Fax
- (815) 366-3349
- NPI assigned
- Jul 8, 2006
- Last updated
- Jan 6, 2014
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | 33904 | WI | Primary |
| Surgery Physician | 208600000X | G037968 | CA | |
| Surgery Physician | 208600000X | MD072888L | PA |
Addresses
Primary practice location
N9781 W Duck Lake Rd # Ktc130
Summit Lake, WI 54485-9629
Mailing address
PO Box 130
Summit Lake, WI 54485-0130
Phone (715) 443-4329
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 31885600 | 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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| G037968 | CA | MD | Surgery Physician |
| MD072888L | PA | MD | Surgery Physician |
| 33904 | WI | MD | Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152316800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1388966400000",
"number": "1942233630",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 130",
"city": "SUMMIT LAKE",
"state": "WI",
"postal_code": "544850130",
"telephone_number": "715-443-4329",
"fax_number": "815-366-3349"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "N9781 W DUCK LAKE RD # KTC130",
"city": "SUMMIT LAKE",
"state": "WI",
"postal_code": "544859629",
"telephone_number": "715-443-4329",
"fax_number": "815-366-3349"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PICONE",
"first_name": "SAMUEL",
"middle_name": "B",
"name_prefix": "Dr.",
"name_suffix": "Jr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-08",
"last_updated": "2014-01-06",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "WI",
"license": "33904",
"primary": true
},
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "CA",
"license": "G037968",
"primary": false
},
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "PA",
"license": "MD072888L",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "31885600",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Summit Lake, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.