DR. RAYMOND T FEDDERLY (MD) – Pediatric Cardiology Physician, NPI 1790736619
Pediatric Cardiology Physician
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
640 PEDIATRIC MEDICINE in WI
Provider Addresses for DR. RAYMOND T FEDDERLY (MD)
2575 E Evergreen Drive
Appleton, WI 549138904
Phone: (920) 969-5353
Fax: (414) 337-7201
Type: Location
4805 S Moorland Rd
New Berlin, WI 531517401
Phone: (262) 798-7200
Fax: (262) 798-7201
Type: Location
1655 W Mequon Rd
Mequon, WI 530923254
Phone: (414) 266-6457
Fax: (414) 266-3261
Type: Location
W180N8085 Town Hall Rd
Menomonee Falls, WI 530513518
Phone: (262) 257-5000
Fax: (262) 518-5052
Type: Location
3200 Pleasant Valley Rd
West Bend, WI 530959274
Phone: (262) 836-7300
Fax: (262) 836-7301
Type: Location
9200 W Wisconsin Ave
Milwaukee, WI 532263522
Phone: (414) 805-6000
Fax: (414) 805-6280
Type: Location
9000, West Wisconsin Avenue, Cannon Park, Wauwatosa, Milwaukee County, Wisconsin, 53226, United States
PEDIATRIC CARDIOLOGY
MILWAUKEE, WI 532264874
Phone: (414) 266-2380
Fax: (414) 266-2294
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2005-06-02
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20050602001119 | I | Pediatric Medicine | WI | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 54913)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Nurse Practitioner | WI | |
| Clinical Psychologist | WI | |
| Neurology, Pediatric Medicine | IL | |
| Pediatric Medicine, Cardiovascular Disease (Cardiology) | WI | |
| Anesthesiology Assistant | WI | |
| Pediatric Medicine, Pulmonary Disease | WI | |
| Diagnostic Radiology | WI | |
| Diagnostic Radiology, Pediatric Medicine | AZ | |
| Diagnostic Radiology, Interventional Radiology | WI | |
| Anesthesiology Assistant | WI |
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