Active NPI
Craig L Nevermann, OD
- Optometrist
- Whitewater, WI
National Provider Identifier
1962453662
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 1509-035
- Practice address
- 128 N Tratt St
Whitewater, WI 53190-1205 - Phone
- (262) 473-4514
- Fax
- (262) 473-3161
- NPI assigned
- May 15, 2006
- Last updated
- Dec 27, 2012
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 1509-035 | WI | Primary |
Addresses
Primary practice location
128 N Tratt St
Whitewater, WI 53190-1205
Mailing address
128 N Tratt St
Whitewater, WI 53190-1205
Phone (262) 473-4514
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 38526400 | Medicaid | WI | |
| 963 | Other | WI | DEAN HEALTH INSURANCE |
| NEVERCRA | Other | WI | MERCYCARE |
| 1006591 | Other | WI | PHYSICIANS PLUS |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1509-035 | WI | MD | Optometrist |
| 1509 | WI | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147651200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1356566400000",
"number": "1962453662",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "128 N TRATT ST",
"city": "WHITEWATER",
"state": "WI",
"postal_code": "531901205",
"telephone_number": "262-473-4514",
"fax_number": "262-473-3161"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "128 N TRATT ST",
"city": "WHITEWATER",
"state": "WI",
"postal_code": "531901205",
"telephone_number": "262-473-4514",
"fax_number": "262-473-3161"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NEVERMANN",
"first_name": "CRAIG",
"middle_name": "L",
"credential": "OD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-15",
"last_updated": "2012-12-27",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "WI",
"license": "1509-035",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "38526400",
"state": "WI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DEAN HEALTH INSURANCE",
"identifier": "963",
"state": "WI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MERCYCARE",
"identifier": "NEVERCRA",
"state": "WI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PHYSICIANS PLUS",
"identifier": "1006591",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Whitewater, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.