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MR. NICHOLAS L ANDERSON
NPI 1366976409
Pediatrics in Neenah, WI

Active since April 15, 2017PECOS Enrolled
130 2ND ST, NEENAH, WI 54956(920) 969-7906(920) 969-7979 Get Directions Write a Review

NPPES record last updated: July 31, 2020. Verified against the NPPES registry weekly; last sync: November 01, 2026.

Record update history: Jul 31, 2020, Jul 9, 2020, Apr 17, 2017 and 1 more (4 updates tracked since 2017).

About Mr. Nicholas L Anderson NPPES

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

MR. NICHOLAS L ANDERSON (NPI 1366976409) is an individual pediatrics provider in Neenah, Wisconsin, licensed in Wisconsin (73724-20) and active in the NPI registry since April 2017. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1366976409
Entity TypeIndividualMale
Primary Taxonomy208000000X
Provider Legal NameMR. NICHOLAS L ANDERSON
Location Address130 2ND STNeenah, WI 54956-2883
Mailing Address130 2nd StNeenah, WI 54956-2883 · (920) 969-7906 · Fax (920) 969-7979
Phone(920) 969-7906
Fax(920) 969-7979
Sole ProprietorNo
Enumeration DateApril 15, 2017
Last NPPES UpdateJuly 31, 20204 updates tracked since enumeration
NPPES CertifiedJuly 31, 2020
✔ NPI 1366976409 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPediatricsAllopathic & Osteopathic Physicians
Taxonomy Code208000000X
License✔ Licensed in WI · 73724-20
Definition
A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development.
130 2ND ST, Neenah, WI 54956
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Other Identifiers 1

Medicaid1366976409WI

Accepted Insurance

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

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Mr. Nicholas L Anderson is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignment

Medicare enrollment records show Nicholas Anderson reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Thedacare, Incorporated
3.2 mi
Counselor
1095 MIDWAY RD
Menasha, WI 54952
  • Reassigned Medicare billing, Wisconsin enrollment
  • 988 clinicians in this Medicare group
NPI 1306959515 (920) 720-2300

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 54956 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$82.92 typical visit price
range $53.90 – $163.24
Typical copayment $20.73 (range $13.47 – $40.81)
Most-billed visit code 99203
Established Patient
$95.41 typical visit price
range $17.40 – $133.76
Typical copayment $23.85 (range $4.35 – $33.44)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 20

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

JENNIFER MARIE KETTERHAGEN PHARMD
Pharmacist
130 2ND ST
NEENAH, WI 54956
Winnebago County (920) 454-5080
JAMES P MANDERLE MD
Nurse Anesthetist, Certified Registered
130 2ND ST, STE. A107
NEENAH, WI 54956
Winnebago County (920) 729-3332
ALLISON A HOELZEL OT
Occupational Therapist
130 2ND ST
NEENAH, WI 54956
Winnebago County (920) 729-2616
ELIZABETH BONSON PT
Physical Therapist
130 2ND ST
NEENAH, WI 54956
Winnebago County (920) 729-2155
SARAH M MARTIN
Physical Therapist
130 2ND ST
NEENAH, WI 54956
Winnebago County (920) 454-2973
JUSTIN EISBERNER
Nurse Anesthetist, Certified Registered
130 2ND ST
NEENAH, WI 54956
Winnebago County (920) 729-3100
DR. ERIK VERHAGE MD
Pediatrics (Neonatal-Perinatal Medicine)
130 2ND ST
NEENAH, WI 54956
Winnebago County (920) 969-7900
ALYSSA ANN ROTZENBERG
Physical Therapist
130 2ND ST
NEENAH, WI 54956
Winnebago County (920) 729-3100

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 Nicholas Anderson's NPI number?

The NPI number for Nicholas Anderson is 1366976409. It was assigned to this individual provider in the NPPES registry on April 15, 2017.

Where is Nicholas Anderson located?

Nicholas Anderson practices at 130 2nd St, Neenah, WI 54956. The listed phone number is (920) 969-7906.

What is Nicholas Anderson's specialty?

The primary specialty registered for this NPI is Pediatrics with taxonomy code 208000000X.

Is Nicholas Anderson enrolled in Medicare?

Yes. Nicholas Anderson is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Nicholas Anderson's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Nicholas Anderson reassigns Medicare benefits to Thedacare, Incorporated (Menasha, WI). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Nicholas Anderson's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Nicholas Anderson accept?

Health plans from CareSource (Common Ground Healthcare) list Nicholas Anderson 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 Nicholas Anderson was last updated on July 31, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 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.