Active NPI
David Fountain
- Contractor
- West Bend, WI
National Provider Identifier
1942820428
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Contractor
- License
- 061900578
- Practice address
- 726 Creedwood Lane
West Bend, WI 53095 - Phone
- (262) 388-6191
- NPI assigned
- Apr 24, 2020
- Last updated
- Apr 24, 2020
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Contractor | 171W00000X | 061900578 | WI | Primary |
Addresses
Primary practice location
726 Creedwood Lane
West Bend, WI 53095
Mailing address
726 Creedwood Lane
West Bend, WI 53095
Phone (262) 388-6191
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 061900578 | WI | MD | Contractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1587686400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1587686400000",
"number": "1942820428",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "726 CREEDWOOD LANE",
"city": "WEST BEND",
"state": "WI",
"postal_code": "53095",
"telephone_number": "262-388-6191"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "726 CREEDWOOD LANE",
"city": "WEST BEND",
"state": "WI",
"postal_code": "53095",
"telephone_number": "262-388-6191"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FOUNTAIN",
"first_name": "DAVID",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-04-24",
"last_updated": "2020-04-24",
"certification_date": "2020-04-24",
"status": "A"
},
"taxonomies": [
{
"code": "171W00000X",
"taxonomy_group": "",
"desc": "Contractor",
"state": "WI",
"license": "061900578",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in West Bend, WI
- Barbara Anne Flaherty, P.T.
- Carey Flanders
- Michelle D Fleischmann, M.D.
- Alina Marie Flint, RN
- Christopher Flood, DDS
- Selena Kim Fraki-Owen, MSPT
- Jonathan France, LPC, SAC-IT
- James Fredrick, SAC-IT
- Beth Ann Freisleben, OT
- Fresenius Medical Care Midwest Dialysis, LLC (Fresenius Medical Care Midwest West Bend)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.