Spine Solutions of West Bend LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

SPINE SOLUTIONS OF WEST BEND LLC

Practice address

1000 Gateway CT Ste 200
West Bend, WI 53095-8541

Phone

(414) 455-1153

NPI assigned

Oct 29, 2020

Last updated

Oct 29, 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

Jeremy Scarlett, MD

Title

Owner

Phone

(414) 455-1153

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Spine Solutions of West Bend LLC

  • Durable Medical Equipment & Medical Supplies
  • West Bend, WI
  • NPI 1811704992

  7517378011

  Same PAC ID

Listed as

Spine Solutions of West Bend LLCCCN 52C0001137

Medicare certification status

ActiveFrom the Provider of Services file

Tax ID family

Spine Solutions of West Bend2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Spine Solutions of West Bend LLC

  • Durable Medical Equipment & Medical Supplies
  • West Bend, WI
  • NPI 1811704992
  NPD tax ID

Locations

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

{
    "created_epoch": "1603929600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1603929600000",
    "number": "1073113841",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2124 KOHLER MEMORIAL DR",
            "city": "SHEBOYGAN",
            "state": "WI",
            "postal_code": "530813169",
            "telephone_number": "414-455-1153"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 GATEWAY CT STE 200",
            "city": "WEST BEND",
            "state": "WI",
            "postal_code": "530958541",
            "telephone_number": "414-455-1153"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPINE SOLUTIONS OF WEST BEND LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-29",
        "last_updated": "2020-10-29",
        "certification_date": "2020-10-29",
        "status": "A",
        "authorized_official_last_name": "SCARLETT",
        "authorized_official_first_name": "JEREMY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "414-455-1153",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kaitlyn Solveson, APRN-NP
• Eric Soneson
• Linda S Sopkowicz, DDS
• Sarah Nicole Sosinski, APNP
• Aristi Spartiatis
• Spine Solutions of West Bend LLC
• Jennifer Ann Spors, SAC-IT
• Melissa Anne Spraggon, LPC-IT
• St. Joseph's Community Hospital of West Bend, Inc. (Froedtert Health St. Joseph's Hospital Pharmacy)
• St. Josephs Community Hospital of West Bend Inc. (Froedtert West Bend Hospital)

• Ambulatory Surgical Clinic/Center in West Bend, WI
• Providers in West Bend, WI by specialty
• Ambulatory Surgical Clinic/Center in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2020; 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.