Individual provider Active NPI

Chasity A Henry, MD

  • Pediatrics Physician
  • Appleton, WI
National Provider Identifier
1992731822
Registry record updated Feb 8, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
49305 Issued in WI
Practice address
2701 E Enterprise Ave
Appleton, WI 54913-7729
Phone
(920) 954-2551
NPI assigned
Jun 23, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 8, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 49305 WI Primary

Addresses

Primary practice location

2701 E Enterprise Ave
Appleton, WI 54913-7729

Mailing address

PO Box 8003
Appleton, WI 54912-8003
Phone (920) 996-3298

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20120412000108 WI Practitioner - Pediatric MedicinePractitioner - Family Practice 9537320965 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pediatric MedicineAlso: Family Practice
Education
University of Wisconsin School of Medicine, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Thedacare, IncorporatedGroup PAC ID 1759294887, 654 clinicians

Practice addresses (Care Compare)

2701 E Enterprise Ave
Appleton, WI 54913-7729
Phone (920) 954-2551

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
49305WIMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Thedacare, Incorporated CurrentSince Mar 3, 2012 Accepting new patients
Thedacare Medical Center - Berlin, Inc. Past Accepting new patients

Locations

2701 E Enterprise Ave
Appleton, WI 54913
Phone (920) 954-2551

W5282 Amy Ave
Appleton, WI 54915
Phone (920) 358-1900

4480 W Spencer St
Appleton, WI 54914
Phone (920) 738-4800

122 E College Ave
Appleton, WI 54911
Phone (920) 996-3264

600 N Westhaven Dr
Oshkosh, WI 54904
Phone (920) 237-5000

Interoperability endpoints

  • Direct secure messaging: chenry3883@direct.thedacare.org

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1151020800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1486512000000",
    "number": "1992731822",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 8003",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549128003",
            "telephone_number": "920-996-3298",
            "fax_number": "920-738-5787"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2701 E ENTERPRISE AVE",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549137729",
            "telephone_number": "920-954-2551"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENRY",
        "first_name": "CHASITY",
        "middle_name": "A",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-23",
        "last_updated": "2017-02-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "WI",
            "license": "49305",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Appleton, WI

Sources for this page

Verify at the official NPI Registry.