Individual provider Active NPI

Steven P Hansen, D.C.

  • Chiropractor
  • De Pere, WI
National Provider Identifier
1992872071
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
3652-012 Issued in WI
Practice address
111 N 5TH St
De Pere, WI 54115-2201
Phone
(920) 336-9355
Fax
(920) 336-9358
NPI assigned
Nov 30, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 3652-012 WI Primary

Addresses

Primary practice location

111 N 5TH St
De Pere, WI 54115-2201

Mailing address

111 N 5TH St
De Pere, WI 54115-2201
Phone (920) 336-9355

Other identifiers 1

IdentifierTypeStateIssuer
38926100MedicaidWI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070215000458 WI Practitioner - Chiropractic 3779504741 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Other, 1999
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

500 Main Ave a
De Pere, WI 54115-2211
Phone (920) 336-9355

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
3652-012WIMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Back in Action Chiropractic Center, LLC Chiropractor CurrentSince Dec 1, 2006 Accepting new patients
Back to Basics Health Center SC Chiropractor Past Accepting new patients
A & E Integrated Health, S.C. Past Accepting new patients
Allied Health of Wisconsin, SC Chiropractor Past Accepting new patients

Locations

111 N 5th St
De Pere, WI 54115
Phone (920) 336-9355

500 Main Ave
Ste A
De Pere, WI 54115
Phone (920) 336-9355

Organizations & group practices 4

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": "1164844800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1992872071",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 N 5TH ST",
            "city": "DE PERE",
            "state": "WI",
            "postal_code": "541152201",
            "telephone_number": "920-336-9355",
            "fax_number": "920-336-9358"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 N 5TH ST",
            "city": "DE PERE",
            "state": "WI",
            "postal_code": "541152201",
            "telephone_number": "920-336-9355",
            "fax_number": "920-336-9358"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HANSEN",
        "first_name": "STEVEN",
        "middle_name": "P",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-30",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "WI",
            "license": "3652-012",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "38926100",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in De Pere, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.