Surya Medical Group SC

Primary specialty

Geriatric Medicine (Family Medicine) PhysicianTaxonomy code 207QG0300X

Legal business name

SURYA MEDICAL GROUP SC

Practice address

6125 Green Bay Rd
Suite 100
Kenosha, WI 53142-2928

Phone

(262) 564-8636

NPI assigned

Jun 15, 2007

Organization subpart

No

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

Authorized official

Name

Ganesh N Pulla, MDNPI 1679620918

Title

Doctor

Phone

(262) 564-8636

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Ganesh N Pulla, M.D

  • Nephrology Physician
  • Kenosha, WI
  • NPI 1679620918
  Medicare reassignment Authorized official

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

{
    "created_epoch": "1181865600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1191542400000",
    "number": "1043415631",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6125 GREEN BAY RD",
            "address_2": "SUITE 100",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531422928",
            "telephone_number": "262-564-8636"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6125 GREEN BAY RD",
            "address_2": "SUITE 100",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531422928",
            "telephone_number": "262-564-8636"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SURYA MEDICAL GROUP SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-15",
        "last_updated": "2007-10-05",
        "status": "A",
        "authorized_official_last_name": "PULLA",
        "authorized_official_first_name": "GANESH",
        "authorized_official_middle_name": "N",
        "authorized_official_title_or_position": "DOCTOR",
        "authorized_official_telephone_number": "262-564-8636",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207QG0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Nephrology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "21279800",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Suresh R Naik MD SC
• Suresh R Naikmd SC
• Surgical Associates of Kenosha S. C.
• Surgical Associates of Kenosha, SC
• Mikayla Rose Surprenant
• Susan M. Cable, DDS, SC
• Lindsay Swartz, RD
• Purnima Swearingen, DDSMSD
• Rebecca Shawn Swenson, FNP
• Hilel Swerdlin, MD

• Geriatric Medicine (Family Medicine) Physician in Kenosha, WI
• Providers in Kenosha, WI by specialty
• Geriatric Medicine (Family Medicine) Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 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.