1. Home
  2. Directory
  3. Wisconsin
  4. Appleton
  5. Non Pharmacy Dispensing Site
  6. NPI Profile

THEDACARE PHYSICIANS PEDIATRICS
NPI 1356424683
Non-Pharmacy Dispensing Site in Appleton, WI

Active since October 23, 2006CLIA Certified · 2 labs
2701 E ENTERPRISE AVE, APPLETON, WI 54913(920) 954-2551(920) 954-2554 Get Directions Write a Review

NPPES record last updated: January 2, 2024. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Jan 2, 2024, Aug 22, 2020 (2 updates tracked since 2020).

About Thedacare Physicians Pediatrics NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

THEDACARE PHYSICIANS PEDIATRICS (NPI 1356424683) is a healthcare organization registered as a non-pharmacy dispensing site in Appleton, Wisconsin and active in the NPI registry since October 2006. The organization holds 2 active CLIA laboratory certificates and lists William Flett, Cfo, as its authorized official.

NPPES Registry Identity

NPI1356424683
Entity TypeOrganization
Primary Taxonomy332900000X
Legal Business NameTHEDACARE, INCORPORATED
Location Address2701 E ENTERPRISE AVEAppleton, WI 54913-7729
Mailing Address2701 E Enterprise AveAppleton, WI 54913-7729
Phone(920) 954-2551
Fax(920) 954-2554
Organization SubpartNo
Authorized OfficialWilliam FlettCfo · (920) 454-4013
Enumeration DateOctober 23, 2006
Last NPPES UpdateJanuary 2, 20242 updates tracked since enumeration
NPPES CertifiedJanuary 2, 2024
✔ NPI 1356424683 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNon-Pharmacy Dispensing SiteSuppliers
Taxonomy Code332900000X
License✔ Licensed in WI · 40901020
Definition
A site other than a pharmacy that dispenses medicinal preparations under the supervision of a physician to patients for self-administration. (e.g. physician offices, ER, Urgent Care Centers, Rural Health Facilities, etc.)
2701 E ENTERPRISE AVE, Appleton, WI 54913
Open in Google Maps ↗

Other Names 1

Doing Business AsThedacare Physicians Pediatrics

Other Identifiers 2

Medicaid32566400WI
Other5127178Other Id Number-commercial Number

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include CareSource (Common Ground Healthcare).Insurance ›

CLIA Laboratory Certificates CMS CLIA 2

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 52D0861163

Thedacare Physicians Pediatrics Appleton · Appleton, WI
Active · expires Apr 14, 2028
CLIA Number52D0861163
Laboratory TypePhysician Office
Certificate Effective DateApril 15, 2026
Certificate Expiration DateApril 14, 2028
Laboratory DirectorDr. Andre Krainik
Laboratory Phone(920) 954-2551
Laboratory LocationThedacare Physicians Pediatrics Appleton2701 E Enterprise Ave, Appleton, WI 54913
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Compliance 52D2181359

Thedacare Family Medicine Gateway · Appleton, WI
Active · expires Dec 15, 2027
CLIA Number52D2181359
Laboratory TypePhysician Office
Certificate Effective DateDecember 16, 2025
Certificate Expiration DateDecember 15, 2027
Laboratory DirectorDr. Jennifer J. Ziebell
Laboratory Phone(920) 454-8444
Laboratory LocationThedacare Family Medicine Gateway3925 N Gateway Drive, Appleton, WI 54913
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.

Other Providers at the Same Location NPPES 19

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

ANDRE KRAINIK MD
Pediatrics
2701 E ENTERPRISE AVE
APPLETON, WI 54913
Outagamie County (920) 954-2551
ELIZABETH E ERMATINGER MD
Pediatrics
2701 E ENTERPRISE AVE
APPLETON, WI 54913
Outagamie County (920) 954-2551
HANNAH T GRACYALNY FNP-C
Nurse Practitioner (Pediatrics)
2701 E ENTERPRISE AVE
APPLETON, WI 54913
Outagamie County (920) 954-2551
MELISSA KORITTNIG NP
Nurse Practitioner
2701 E ENTERPRISE AVE
APPLETON, WI 54913
Outagamie County (920) 954-2551
SHARON RINK MD
Pediatrics
2701 E ENTERPRISE AVE
APPLETON, WI 54913
Outagamie County (920) 954-2551
VICTORIA M NEUMAN APNP
Nurse Practitioner
2701 E ENTERPRISE AVE
APPLETON, WI 54913
Outagamie County (920) 954-2551
MICHAEL JAKUBOWSKI MD
Pediatrics
2701 E ENTERPRISE AVE
APPLETON, WI 54913
Outagamie County (920) 954-2551
MRS. KRISTIN K LUNDINE APNP
Nurse Practitioner (Pediatrics)
2701 E ENTERPRISE AVE
APPLETON, WI 54913
Outagamie County (920) 954-2551

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Thedacare, Incorporated's NPI number?

The NPI number for Thedacare, Incorporated is 1356424683. It was assigned to this organization in the NPPES registry on October 23, 2006. The provider is doing business as Thedacare Physicians Pediatrics.

Where is Thedacare, Incorporated located?

Thedacare, Incorporated is located at 2701 E Enterprise Ave, Appleton, WI 54913. The listed phone number is (920) 954-2551.

What is Thedacare, Incorporated's specialty?

The primary specialty registered for this NPI is Non-Pharmacy Dispensing Site with taxonomy code 332900000X.

Does Thedacare, Incorporated hold CLIA laboratory certificates?

Yes. 2 active CLIA laboratory certificates are associated with this NPI under the federal Clinical Laboratory Improvement Amendments program. The certificates are listed in the CLIA Laboratory Certificates section above.

What insurance does Thedacare, Incorporated accept?

Health plans from CareSource (Common Ground Healthcare) list Thedacare, Incorporated as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Thedacare, Incorporated was last updated on January 2, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.