John P. Modrzynski, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

23162 Issued in WI

Practice address

N2934 State Road 22
Wautoma, WI 54982-5267

Phone

(920) 787-4613

Fax

(920) 787-5433

NPI assigned

Feb 7, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jmodrzynski120087@direct.thedacare.org

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.

• Thedacare, Incorporated

  • Family Medicine Physician
  • New London, WI
  • NPI 1376656959

  Family Medicine, WI

  Medicare reassignment NPD

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

{
    "created_epoch": "1139270400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1962475434",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "122 E COLLEGE AVE",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549115794",
            "telephone_number": "920-787-4613",
            "fax_number": "920-787-5433"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "N2934 STATE ROAD 22",
            "city": "WAUTOMA",
            "state": "WI",
            "postal_code": "549825267",
            "telephone_number": "920-787-4613",
            "fax_number": "920-787-5433"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "N2034 Highway 22",
            "address_purpose": "LOCATION",
            "city": "Wautoma",
            "state": "WI",
            "postal_code": "54982",
            "country_code": "US",
            "telephone_number": "920-787-4613",
            "fax_number": "920-787-5433",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "N2034 Highway 22",
            "address_purpose": "LOCATION",
            "city": "Wautoma",
            "state": "WI",
            "postal_code": "54982",
            "country_code": "US",
            "telephone_number": "920-787-4613",
            "fax_number": "920-787-5433",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MODRZYNSKI",
        "first_name": "JOHN",
        "middle_name": "P.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-07",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "23162",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "32833700",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Dianne L Martinez, PTA
• Cynthia Marie McMahon
• Karen E McQuown, DENTAL HYGIENIST
• Brian L Meckelberg, OD
• Kayla Meilick, RDH
• Bonnie Sue Monaghan, RDH
• Virginia Ellen Moon, M.S.
• Toni Ann Morgan-Jones, PHD
• Renee Murphy, MD
• Emily Nault

• All providers in Wautoma, WI
• Family Medicine Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.