Organization Active NPI

Advanced Retina S.C.

  • Retina Specialist (Ophthalmology) Physician
  • Greenfield, WI
National Provider Identifier
1063173128
Registry record updated Jan 5, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Retina Specialist (Ophthalmology) PhysicianTaxonomy code 207WX0107X
Legal business name
ADVANCED RETINA S.C.
Practice address
4131 W Loomis Rd Ste 240
Greenfield, WI 53221-2072
Phone
(262) 510-0300
Fax
(262) 510-0500
NPI assigned
Dec 31, 2021
Last updated
Jan 5, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 5, 2025

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

Authorized official

Name
Ryan Vogel, MDNPI 1124361142
Title
President
Phone
(414) 573-5946

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Retina Specialist (Ophthalmology) PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207WX0107X Primary

Addresses

Primary practice location

4131 W Loomis Rd Ste 240
Greenfield, WI 53221-2072

Mailing address

4131 W Loomis Rd Ste 240
Greenfield, WI 53221-2072
Phone (262) 510-0300

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220223000783 WI Part B Supplier - Clinic/Group Practice 4082008792 Receives reassigned benefits from 3 practitioners
Practice locations: Greenfield, WI; Mequon, WI; Waukesha, WI

National Provider Directory

National Provider Directory

Locations

385 Williamstowne
Ste 101
Delafield, WI 53018
Phone (262) 444-0124

1249 W Liebau Rd
Ste 201
Mequon, WI 53092
Phone (262) 510-0300

4131 W Loomis Rd
Ste 240
Milwaukee, WI 53221
Phone (262) 510-0300

N19W24133 Riverwood Dr
Ste 190
Waukesha, WI 53188
Phone (262) 510-0300

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1640908800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1736035200000",
    "number": "1063173128",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4131 W LOOMIS RD STE 240",
            "city": "GREENFIELD",
            "state": "WI",
            "postal_code": "532212072",
            "telephone_number": "262-510-0300",
            "fax_number": "262-510-0500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4131 W LOOMIS RD STE 240",
            "city": "GREENFIELD",
            "state": "WI",
            "postal_code": "532212072",
            "telephone_number": "262-510-0300",
            "fax_number": "262-510-0500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED RETINA S.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-12-31",
        "last_updated": "2025-01-05",
        "certification_date": "2025-01-05",
        "status": "A",
        "authorized_official_last_name": "VOGEL",
        "authorized_official_first_name": "RYAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "414-573-5946",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207WX0107X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Ophthalmology, Retina Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Greenfield, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.