SSC Pleasant Prairie Operating Company LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

5005 Issued in WI

Legal business name

SSC PLEASANT PRAIRIE OPERATING COMPANY LLC

Practice address

10330 Prairie Ridge Blvd
Pleasant Prairie, WI 53158-1947

Phone

(262) 612-2800

NPI assigned

Apr 3, 2007

Organization subpart

No

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

Authorized official

Name

Thomas P. Simons

Title

Senior VP Operations Finance

Phone

(770) 829-5100

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Grande Prairie Health and Rehabilitation Center Doing business as

Electronic endpoints 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1175558400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1605571200000",
    "number": "1003937475",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5300 W SAM HOUSTON PKWY N",
            "address_2": "SUITE 100",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770415161",
            "telephone_number": "832-467-6000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10330 PRAIRIE RIDGE BLVD",
            "city": "PLEASANT PRAIRIE",
            "state": "WI",
            "postal_code": "531581947",
            "telephone_number": "262-612-2800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SSC PLEASANT PRAIRIE OPERATING COMPANY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-03",
        "last_updated": "2020-11-17",
        "certification_date": "2020-11-17",
        "status": "A",
        "authorized_official_last_name": "SIMONS",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "P.",
        "authorized_official_title_or_position": "SENIOR VP OPERATIONS FINANCE",
        "authorized_official_telephone_number": "770-829-5100"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "WI",
            "license": "5005",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "20194800",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREVIOUS MEDICAID NUMBER",
            "identifier": "20186700WI",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://199.119.81.30:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRResponse_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.1066.1",
            "affiliationName": "eSolutions Inc",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMDR eMDR",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "8215 W 108th Ter",
            "city": "Overland Park",
            "state": "KS",
            "country_code": "US",
            "postal_code": "662101661",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Grande Prairie Health and Rehabilitation Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Grande Prairie Health and Rehabilitation Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Sarah M Slivon-Vanchena, APNP
• Gina Smolik, PHARMD
• Lauren Michelle Snower, M.D.
• Farrah Sonnenberg
• Courtney Sperry, PA-C
• Jacqueline A Stark, CPNP
• Michael Stark
• Natalia Stasior, MD
• Matthew Eric Stauffer, MD
• Hannah Steele

• Skilled Nursing Facility in Pleasant Prairie, WI
• Providers in Pleasant Prairie, WI by specialty
• Skilled Nursing Facility in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.