Summit Medical Specialists, SC

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

33398 Issued in WI

Legal business name

SUMMIT MEDICAL SPECIALISTS, SC

Practice address

2717 N Grandview Blvd Ste 202
Waukesha, WI 53188-1660

Phone

(262) 513-0700

Fax

(262) 513-0707

NPI assigned

Apr 20, 2007

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Tim Levenhagen, MD

Title

Owner

Phone

(262) 513-0700

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1177027200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1053538843",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2717 N GRANDVIEW BLVD STE 202",
            "city": "WAUKESHA",
            "state": "WI",
            "postal_code": "531881660",
            "telephone_number": "262-513-0700",
            "fax_number": "262-513-0707"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2717 N GRANDVIEW BLVD STE 202",
            "city": "WAUKESHA",
            "state": "WI",
            "postal_code": "531881660",
            "telephone_number": "262-513-0700",
            "fax_number": "262-513-0707"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUMMIT MEDICAL SPECIALISTS, SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-20",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "LEVENHAGEN",
        "authorized_official_first_name": "TIM",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "262-513-0700",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "WI",
            "license": "33398",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "32189000",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Psychiatry Physician in Waukesha, WI
• Providers in Waukesha, WI by specialty
• Psychiatry Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 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.