NPIMap

Individual provider Active NPI

Bonnie M Samuelson, M.D.

  • Family Medicine Physician
  • Crandon, WI
National Provider Identifier
1962432658
Registry record updated Mar 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
43356 Issued in WI
Practice address
8201 Mish Ko Swen Dr
Crandon, WI 54520-8631
Phone
(715) 478-4300
NPI assigned
Jul 5, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 21, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 43356 WI
Family Medicine Physician 207Q00000X 43356 WI Primary

Addresses

Primary practice location

8201 Mish Ko Swen Dr
Crandon, WI 54520-8631

Mailing address

3000 Westhill Dr
Suite 303
Wausau, WI 54401-3795

Other practice location 1

2720 Plaza Dr
Suite 1100
Wausau, WI 54401-4158
Phone (715) 847-2472

Other identifiers 1

IdentifierTypeStateIssuer
34087600MedicaidWI

Other names 1

  • Bonnie M Fritz Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address him@marshfieldclinichealthsystem.cernerdirect.com Health Information Exchange (HIE)

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
I20081204000391 WI Practitioner - Emergency MedicinePractitioner - Family Practice 8426029786 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency MedicineAlso: Family Practice
Education
University of Wisconsin School of Medicine, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Forest County Potawatomi CommunityGroup PAC ID 3375454689, 21 clinicians

Practice addresses (Care Compare)

8201 Mish Ko Swen Dr
Crandon, WI 54520-8631
Phone (715) 478-4300

Hospital & facility affiliations

  • Aspirus Rhinelander Hospital Hospital, Rhinelander, WI, CCN 520019
  • Langlade Hospital Hospital, Antigo, WI, CCN 521350

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
43356WIMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
MCHS Hospitals Inc CurrentSince Aug 26, 2019 Accepting new patients
MCHS Hospitals Inc Emergency Medicine CurrentSince Aug 26, 2019 Accepting new patients
Marshfield Clinic Inc CurrentSince Aug 26, 2019 Accepting new patients
Forest County Potawatomi Community CurrentSince Mar 21, 2022 Accepting new patients
Aspirus Medical Group, Inc. Past Accepting new patients

Locations

501 Aurora St
Antigo, WI 54409
Phone (715) 623-2331

8201 Mish Ko Swen Dr
Crandon, WI 54520
Phone (715) 478-4300

3501 Golf Rd
Eau Claire, WI 54701
Phone (715) 858-4200

1000 Starr Ave
Eau Claire, WI 54703
Phone (715) 858-4850

1000 N Oak Ave
Marshfield, WI 54449
Phone (715) 387-5111

4100 State Highway 66
Stevens Point, WI 54482
Phone (715) 343-7700

333 Pine Ridge Blvd
Wausau, WI 54401
Phone (715) 847-2160

3000 Westhill Dr
Ste 303
Wausau, WI 54401

Interoperability endpoints

  • Direct secure messaging: him@marshfieldclinichealthsystem.cernerdirect.com

Organizations & group practices 5

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 18

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

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1152057600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1647820800000",
    "number": "1962432658",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3000 WESTHILL DR",
            "address_2": "SUITE 303",
            "city": "WAUSAU",
            "state": "WI",
            "postal_code": "544013795"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8201 MISH KO SWEN DR",
            "city": "CRANDON",
            "state": "WI",
            "postal_code": "545208631",
            "telephone_number": "715-478-4300"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2720 Plaza Dr",
            "address_2": "Suite 1100",
            "address_purpose": "LOCATION",
            "city": "Wausau",
            "state": "WI",
            "postal_code": "544014158",
            "country_code": "US",
            "telephone_number": "715-847-2472",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SAMUELSON",
        "first_name": "BONNIE",
        "middle_name": "M",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-05",
        "last_updated": "2022-03-21",
        "certification_date": "2022-03-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "WI",
            "license": "43356",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "43356",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "34087600",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "him@marshfieldclinichealthsystem.cernerdirect.com",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "2720 Plaza Dr",
            "address_2": "Suite 1100",
            "city": "Wausau",
            "state": "WI",
            "country_code": "US",
            "postal_code": "544014158",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "BONNIE",
            "last_name": "FRITZ",
            "middle_name": "M",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Crandon, WI

Sources for this page

Verify at the official NPI Registry.