Individual provider Active NPI

Deborah L Kosobucki, APNP

  • Nurse Practitioner
  • Plover, WI
National Provider Identifier
1992852230
Registry record updated May 23, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
1194 Issued in WI
Practice address
2401 Plover Road
Plover, WI 54467
Phone
(715) 259-3800
NPI assigned
Jan 5, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 23, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 1194 WI Primary

Addresses

Primary practice location

2401 Plover Road
Plover, WI 54467

Mailing address

900 Illinois Avenue
Stevens Point, WI 54481

Other identifiers 1

IdentifierTypeStateIssuer
43877100MedicaidWI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050208000957 WI Practitioner - Nurse Practitioner 9436100328 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1194WIMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Aspirus Stevens Point Hospital & Clinics, Inc. CurrentSince Jun 1, 2005 Accepting new patients
Aspirus Stevens Point Hospital & Clinics, Inc. CurrentSince Jun 1, 2005 Accepting new patients

Locations

29980 Network Pl
Chicago, IL 60673

2401 Plover Rd
Plover, WI 54467
Phone (715) 259-3800

824 Illinois Ave
Stevens Point, WI 54481
Phone (715) 342-7500

900 Illinois Ave
Stevens Point, WI 54481
Phone (715) 342-7500

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": "1167955200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1211500800000",
    "number": "1992852230",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 ILLINOIS AVENUE",
            "city": "STEVENS POINT",
            "state": "WI",
            "postal_code": "54481"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2401 PLOVER ROAD",
            "city": "PLOVER",
            "state": "WI",
            "postal_code": "54467",
            "telephone_number": "715-259-3800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOSOBUCKI",
        "first_name": "DEBORAH",
        "middle_name": "L",
        "credential": "APNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-05",
        "last_updated": "2008-05-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "WI",
            "license": "1194",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "43877100",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Plover, WI

Sources for this page

Verify at the official NPI Registry.